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Medicare Part B

What Medicare Part B covers?

Medicare Part B is also referred to as medical insurance or outpatient insurance. It is going to provide coverage to services medically necessary and preventative. Medically necessary services are services that are needed to diagnose and treat medical conditions. Preventative services are going to be services that help detect and/or hopefully prevent illness. Part B has quite a bit of different services that are covered, so we are going to break down each coverage under Part B.

Doctor services: Visits to doctor's office and other outpatient visits that are medically necessary are covered.

Ambulance: Emergency transportation provided by ambulance is covered when medical services from a hospital or skilled nursing facility is needed. There is limited coverage available if ambulance is used for non-emergency transportation, when medically necessary.

Durable Medical Equipment: Durable Medical equipment is going to provide coverage to a lot of items such as: Wheelchairs, blood sugar strips, canes, crutches, hospital beds, oxygen, walkers, and more! As long as your doctor prescribes you the equipment it will fall under DME. 

Mental Health: Mental health services are covered as inpatient and outpatient. Under inpatient Mental Health, coverage reverts to Part A. Outpatient Mental Health services are covered under Part B and will provide coverage to depression screening, family counseling, individual counseling, psychiatric evaluation, and diagnostic tests. 

AIS Medicare & More agents specialize in Medicare insurance and are going to work to ensure that the plan you choose is the option that meets your health and financial needs

Who Qualifies for Medicare Part B

People who are 65 or older that are citizens or permanent residents of the United States are eligible for Part A. 

People under 65 that are entitled to Social Security Disability for 24 months, have ALS, or have ESRD are entitled to Part A as well.

How to Apply for Medicare Part B

Applying for Part B can happen a couple different ways. 

Automatic enrollment:

Automatic enrollment happens when you are already drawing Social Security or Railroad Retirement and will become active the 1st of the month of your 65th birthday month. 

Manual enrollment:

Manual enrollment happens when you are not drawing Social Security or Railroad Retirement, you can do this by going to social security website, calling social security, going in person, or mailing social security your application. If you are not staying on a group plan you should plan to start this process about 3 months before your birthday.

How Much does Medicare Part B cost

Medicare Part B for most individuals will be $174.70 a month in premium. However, if you have high income your Part B premiums can be increased and if you have low income your Medicare Part B premium can be reduced.

Part B Deductible: The Part B deductible in 2024 is $240 per year.

Part B Coinsurance: After the Medicare Part B annual deductible has been met, all covered services become an 80/20 split, meaning you pay 20% for all covered services the rest of the year. Medicare has no limit when it comes to medical expenses, or no Out-of-Pocket maximum. This is why we recommend adding a Medicare Supplement or Medicare Advantage to your Medicare to help cost contain medical expenses. 

Excess Charges: Excess Charges with Medicare Part B is where a medical provider can charge an additional 15% on top of the Medicare approved fees. This would be in addition to the 20% coinsurance that you are responsible for. 

●IRMAA is a surcharge that people with income above a certain amount must pay in addition to their Medicare Part B and Part D premiums.

●The Social Security Administration (SSA) determines who pays an IRMAA based on the income reported 2 years prior (MAGI), every year.

●If the SSA determines you must pay an IRMAA, you’ll receive a notice with the new premium amount and the reason for their determination.

IRMAA (Income Related Medicare Adjustment Amount)

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