Let's learn about part B

Part B is also know as Doctors Insurance!

Medicare Part B is comprehensive medical insurance. It covers medical services and supplies that are medically necessary to treat your health condition.

This includes outpatient care, preventive services, ambulance services, and durable medical equipment.

Medicare Part B covers:

  • Welcome to Medicare” Visit
  • Doctors’ Visits
  • Ambulance
  • Lab Testing
  • Home Health Care
  • Flu & Hep B Shots
  • Cardiovascular & Cancer Tests
  • Diabetes Tests
  • Colonoscopies & Mammograms
  • Radiation & Chemotherapy
  • Medical Equipment
  • Insulin & Other Infused Drugs

For a full list of services covered under Part B, refer to your “Medicare and You” book.”

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Who is Eligible for Part b?

You may qualify if you are 65 or older and:

  • You are a U.S. citizen or a permanent legal resident who has lived in the United States for at least five years.
  • You or your spouse has worked long enough to be eligible.
  • You or your spouse is a government employee or retiree who has not paid into Social Security but has paid Medicare payroll taxes while working.

Younger than 65?

You may qualify under 65 if:

  • You have been entitled to Social Security disability benefits for at least 24 months.
  • You receive a disability pension from the Railroad Retirement Board.
  • You have Lou Gehrig’s disease, also known as amyotrophic lateral sclerosis.
  • You have permanent kidney failure requiring regular dialysis or a kidney transplant.

Part b Premium?

The standard monthly premium for Medicare Part B enrollees will be $144.60 for 2020.

Part B monthly premium is based on your income. Most people will pay the standard premium but if your income is higher you might pay more. Income-related monthly adjustment amounts (IRMAA) affect only about 5 percent of people with Medicare.

Deductible & Coinsurance

You will have to pay an annual deductible of $198 in 2020 . That means when you receive services covered by Part B, you will pay the first $198 before Medicare starts paying anything. You only pay this deductible once per year.

Once you have paid your deductible, you will then pay 20% of all Medicare approved bills. That means if the bill is $1000, you have to pay $200.

How & When can you Enroll?

Your Medicare Initial Enrollment Period is probably the most important date for you to know as you’re approaching Medicare eligibility.

Your Initial Enrollment Period (or IEP) lasts for seven (7) months. It begins three months before the month of your 65th birthday. It then includes the month of your birthday, and extends for three months after your birthday month.

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During the IEP, you can enroll in Original Medicare Part A and Part B or a Advantage plan (Part C). Enrolling during your IEP avoids any late enrollment penalty.

You can also avoid late penalties for Part D by enrolling drug coverage during this same window. That drug coverage can be a standalone plan or part of a Medicare Advantage plan that includes Part D.

If you enroll in Original Medicare, you may want additional coverage with a Medicare Supplement Plan (Medigap).

What happens if you miss your Initial Enrollment?

There are a number of unpleasant consequences you might face if you don’t sign up for coverage during your IEP. These apply only if you do not have other creditable coverage, like employer coverage.

Let’s break them down:

  • If you don’t enroll in Part B during your IEP, you’ll probably have to pay a late enrollment penalty for as long as you have Medicare coverage. The penalty is 10% for every 12-month period you should have had Part B, but didn’t enroll.
  • If you don’t sign up during your IEP, you’ll have to wait until the next General Enrollment Period (GEP) which is every year form Jan 1 to March 31. Your coverage won’t start until July 1 that year.
  • If you don’t have creditable Part D prescription drug coverage and miss your IEP, you’ll pay a penalty with your Part D premium again, as long as you have the coverage. The penalty is 1% per consecutive month that you went without coverage.
  • In the rare situation where you don’t qualify for premium-free Part A because you don’t have enough work credits, and you don’t buy it during your IEP, you’ll pay a 10% premium penalty for twice the number of years you could have bought the coverage but didn’t.

What is Credible Coverage?

In many cases, people are still working and have group coverage through an employer or union plan.  This allows you to delay enrollment in Part A and/or B.  When you retire or lose your credible coverage, you can sign up during a Special Enrollment Period (SEP).

If you qualify, you get a 63-day Special Enrollment period to sign up for Parts A and/or B with no late penalties.

This Special Enrollment Period is an eight-month period that begins either the month you or your spouse quits working or the month your group coverage ends, whichever comes first.

What & When is the General Enrollment Period?

If you missed your IEP and you don’t qualify for a special enrollment period, you can sign up for Original Medicare during the General Enrollment Period (GEP). This runs from January 1 through March 31 each year.

 

Don’t be fooled into thinking the GEP is a safety net so you don’t have to worry about your IEP. Even though you can enroll in Original Medicare during this time, you are still subject to the late enrollment penalties.

Your coverage won’t begin until July 1, which means you may go without coverage for months.

Keep in mind that the General Enrollment Period only applies to Original Medicare. If you want a Advantage plan or Part D coverage, you’ll have to wait for the Annual Enrollment Period.

You have to make a few decisions on how you will protect yourself from the charges that Medicare does not cover. Most people choose between two choices.

  1. You can keep Original Medicare, buy a Part D prescription plan and cover the remaining charges that Medicare does not pay with a Medicare Supplement Plan (Medigap).
  2. You can join an Advantage plan (Part C) plan.

Take a moment to learn about both so that you can make an informed decision.

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If you have Questions, you can Speak with your local agent now

Daniel Vujinovic
Daniel - Senior Agent

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