Medicare Part B, or medical insurance, covers the costs of medical services and supplies for the diagnosis or treatment of a health condition. This policy covers outpatient and preventative services such as hospital visits and disease screenings.
Medicare Part A, by contrast, covers inpatient and hospital coverage. Medicare Part A and B combined, form Original Medicare. Following are essential facts policyholder’s need to know about Medicare Part B coverage in 2022.
Medicare Part B covers medical services and supplies your physician requires to treat a policyholder’s health condition. The following are examples of costs covered by Medicare Part B:
Medicare Part B will cover most preventative services if the patient visits a health care provider that accepts assignment. Facilities that take assignment are paid directly by Medicare, ensuring approval, and payment of supplies and services.
The Medicare Advantage Plan includes both Part A and Part B coverage, offered through Medicare contracted private insurance companies. Advantage plans are legally obligated to provide the same benefits as Original Medicare. Additionally, Advantage plans may provide coverage typically excluded from the standard Part B policy. Such services could include dental, vision, hearing, and additional prescription drug coverage.
Individuals who meet eligibility requirements for premium-free Medicare Part A coverage are automatically eligible for Part B coverage. Medicare Part A coverage is available for individuals over the age of 65, people with disabilities, and those with end-stage renal disease. Medicare.gov offers an online tool to help determine Medicare eligibility. However, those who do not qualify for Medicare Part A coverage may still be eligible for Part B if they meet one or more of the following criteria:
Individuals with disabilities may automatically qualify for auto-enrollment in both Part A and Part B coverage. Individuals under the age of 65, receiving Social Security and Railroad Retirement Board disability benefits for 24 consecutive months, will automatically be enrolled for both Medicare plans. Those with amyotrophic lateral sclerosis disease may also qualify for Plan B coverage before the age of 65.
It’s recommended to enroll for Medicare Part B for 2022 as soon as you’re eligible. Those receiving retirement benefits before the age of 65 as well as disability recipients, usually are automatically enrolled for Medicare Part A and B when they become eligible.
For those who aren’t automatically enrolled, applications for Medicare are available at the Social Security office, visiting their website, or calling the toll-free number (1-800-772-1213). TTY users can contact 1-800-325-0778.
Typically, eligible recipients are invited to enroll during the initial enrollment period if they do not qualify for a special enrollment period. However, those who miss both appointments, the annual General Enrollment Period, from January 1st to March 31st, offers another chance to join. Coverage would then begin starting July 1st. Keep in mind, that late enrollment penalties may apply for not signing up during initial eligibility.
From the moment an individual turns 65 and obtains Medicare Part B coverage, there is a six-month window of opportunity to sign up for a Medigap or Supplemental Medicare insurance. During this time, policyholders have a guaranteed-issue right to a Medigap plan without having to pay higher premiums as a result of a pre-existing health condition.
Some people are eligible for premium-free Medicare coverage. However, many have to pay a monthly fee for Part B coverage. For those already enrolled in an employer-sponsored group plan, or those covered under a spouse’s plan, it may be wise to delay enrollment.
For individuals who are still working, they should consult with their current health insurance provider to find out if their current plan can work with Medicare. Those who already have employer health coverage can sign up for Medicare during the annual enrollment period, without paying a late fee. Once the employer health coverage ends, an individual has an eight-month grace period, in which a special, penalty-free enrollment period opens. Important to note is retiree policies, and COBRA do not qualify an individual for a special enrollment period.
Monthly premiums are based on an individual’s income as follows. A late enrollment penalty may apply to individuals who did not enroll in Medicare Part B as soon as they were eligible. In this case, monthly premiums can cost up to 10% more each year that a qualified individual does not enroll.
|Less than $85,000||Up to |
In addition to monthly premiums, policyholders shouldn’t forget the yearly deductible of $183. Individuals may also be responsible for a copayment regarding specific outpatient services. Typically, a policyholder will then pay 20% of approved medical services. Medicare Part B will then pay the remaining 80%.
For some services covered by Medicare Part B, policyholders will have to pay an annual deductible. Yearly deductibles for Part B are $183. Additionally, policyholders often must pay 20% of the Medicare-approved amount out-of-pocket before Medicare coverage takes over.
Supplemental coverage, such as Medicaid, Medigap plan C or F, and employer-sponsored plans can help pay deductibles. However, Medigap plans will only be sold through 2019. Starting 2020, Medigap plans that cover the Part B deductible will no longer be open for enrollment. Those who already have Medigap coverage, however, will not lose their coverage.
The elimination of Medigap plans in the near future is a result of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). To steer away from quantity-based systems and improve the quality of senior care, this new legislation is encouraging more out-of-pocket spending from policyholders.
Original Medicare policyholders can get help paying for deductibles by signing up for Medigap insurance. Ten Medigap plans will still be available in 2019, with plans C and F covering the cost of the Part B deductible. Massachusetts, Minnesota and Wisconsin Medigap plans are standardized differently, so policyholders in these states should review local regulations.
Medigap plans range in price, depending on the insurance provider. To find the best price, policyholders should reach out to a licensed insurance agent and compare plans before making a final decision. In a few states, a different type of Medigap policy, known as Medicare SELECT is available as an alternative. This plan only covers medical care from a healthcare facility included on a list of approved partner physicians.
Medicare Part B covers outpatient and medical services, usually in combination with Medicare Part A, which includes inpatient and hospital services. With a Medicare Advantage Plan, policyholders can gain coverage not typically offered by Part B, such as dental, vision, and hearing policies.
Those over the age of 65, receiving disability benefits, or suffering from renal disease are eligible for Medicare Part B coverage. Many times, individuals will be enrolled automatically. If not, they should consult with their local Social Security office and health insurance provider. It may be sensible to delay enrollment if an individual is still enrolled in an employer-based insurance program.
Premiums start at $134 and range according to individual income levels. Annual deductibles of $183 can be avoided by signing up for Medigap or another Medicare Supplemental Insurance program. Medigap programs that pay Part B deductibles will still be available for 2019, after which these plans will be discontinued.