Medicare Part B is a type of Medicare health insurance that covers medical services that are not covered by Part A. This includes medical services like doctors’ visits and outpatient care, ambulance services, clinical research (like lab exams, tests, and screenings meant to prevent, find, or manage a medical issue), some mental health care (including inpatient and outpatient services, and short hospital stays), and some outpatient prescription drugs. Medicare Part B is optional, but alongside Part A it is part of Original Medicare, meaning that when you enroll in Medicare when you turn 65, you will likely be enrolled in both Part A and Part B.
In order for services to be covered by Medicare Part B, they must be considered medically necessary. This means that Part B does not cover dental and vision care, and drug prescriptions that are taken at home.
If your medical needs are not covered by Medicare Part B, there are plans you can purchase — known as supplemental Medicare plans, or Medigap plans — that may offer better coverage for your specific health concerns and requirements.
The monthly premium cost for Medicare Part B in 2021 is $148.50. This amount may be higher, depending on your income — if you reported a gross annual income of more than $88,000 two years before you enrolled in Medicare, you will pay an Income Related Monthly Adjustment Amount (IRMAA) charge on top of the standard monthly Part B premium cost. For instance, for incomes between $88,000 and $111,000, the monthly Part B premium in 2021 is $207.90.
You will also have to pay a deductible for your Part B insurance. In 2021, the standard deductible for Medicare Part B insurance is $203. After you pay this deductible for the year, you typically pay 20% of the Medicare-approved amount for services including doctors’ services, inpatient services, outpatient therapy, and durable medical equipment (DME).
If your medical needs are not covered by Medicare Part B, there are a number of alternatives. If you are still employed when you become eligible for Original Medicare, you may opt to continue benefiting from your employer’s health plan until you retire. At that time, you can enroll in Original Medicare — which comprises Medicare Part A and Part B — and look into a Medigap plan, which will offer you coverage that is not offered by Medicare Part B.
However, which Medigap plan you opt into will depend on your specific medical needs. Medigap plans are Medicare supplement plans that fill gaps in Original Medicare. These types of plans are sold by private insurance companies. Medigap plans can help cover additional expenses not covered by Original Medicare, including copays and coinsurance costs, deductible costs, blood transfusions, hospice stays, out-of-country healthcare expenses, and cost associated with lengthier hospital stays.
The amount and type of coverage offered by these plans depend on which plan you purchase. Generally, there are 10 different Medigap plans available (this will depend on your state of residence), all of which offer different tiers of coverage, with different monthly premiums and deductible costs. They are all sold by private insurance companies but are standardized and regulated by the U.S. Centers for Medicare and Medicaid Services. The Medigap plan that is most suitable for you will depend on your specific medical needs. (Source)
In addition, you may wish to enroll in Medicare Part D, which is Medicare’s prescription drug coverage plan. This plan can be purchased as an add-on to Original Medicare. Medicare Part D is also part of Medicare Advantage plans, which combine Medicare Parts A, B and C. If you anticipate that prescription drug costs will be a significant part of your healthcare expenses, a Medicare plan that includes Part D, like Medicare Advantage, may offer you the most comprehensive coverage for your needs. You may also be covered by TRICARE, the Department of Veterans Affairs (VA), the Indian Health Service; check your coverage before purchasing a Medigap or Medicare Advantage plan, before opting in to Medicare part D. (Source)
In order to determine what type of Medicare plan is suitable for you as an alternative — or an add-on — to Medicare Part B, you should first determine what your specific health and medical needs are. This will help you determine what type of plan is ideal for you. In addition, ensure that you do not have any existing coverage, such as health insurance coverage from TRICARE, the Indian Health Service, or from your employer (if you are still employed when you become eligible for Medicare) that already covers health expenses that are not covered by Medicare Part B.
Next, if you have determined that there are gaps in your coverage, you will need to determine which Medigap or Medicare Advantage plans are available in your county of residence, and what your budget for additional or supplementary medical insurance is. Speak to an insurance broker, or use our comparison tool to better determine what types of plans might suit your budget, as well as your medical needs.