Medicare, the Federal Government’s Healthcare Plan for the Elderly and Other Selected Populations, is available to anyone who meets specific criteria and is 65 or older. There are various sections to it, and Part B is just one of them.

Part B of Medicare can be used for many different types of outpatient care. Read on to learn about Medicare Part B, such as its benefits, premiums, and enrollment windows. Let’s start with what is medicare Part B.

What Is a Medicare Part B Plan, and What Does It Cover?

The original Medicare system includes both Part A and Part B. According to experts, by the end of 2016, about 67% of Medicare beneficiaries were covered in original Medicare.

Several types of outpatient care are covered by Part B. When a service is essential for diagnosing or treating a patient’s health issue, it is considered “medically necessary.”

Some services that fall under Part B include:

  • Getting an ambulance during emergencies
  • Chemotherapy
  • Long-lasting medical equipment, including walkers, wheelchairs, and oxygen equipment
  • Emergency room care
  • Kidney dialysis
  • Lab tests, like blood tests and urinalysis
  • Occupational therapy
  • Outpatient care and care for mental illness
  • Physical therapy
  • Transplants

Part B coverage also includes some preventive services such as:

  • bone density assessment
  • cancer screenings for colorectal, prostate, and breast diseases
  • screenings for cardiovascular diseases
  • Diabetic monitoring
  • hepatitis B, hepatitis C, and HIV testing
  • screening for STIs (sexually transmitted infections)
  • immunizations against pneumococcal illness, hepatitis B, and the flu

Services Not Covered by Part B

Specific medical care is excluded from Medicare’s Part B coverage. You’ll have to shell out your cash if you want to take advantage of these options. Here are a few examples:

  • Regular physical checkups
  • commonly used pharmaceuticals
  • Dentures and other dental work
  • most eyecare services, such as contact lenses or eyeglasses
  • assistance for the hearing impaired
  • care for the elderly
  • Surgical Improvement of Appearance
  • complementary and alternative medicine (CMM) treatments

A Medicare Part D program provides coverage for prescription drugs. Private insurance carriers’ Part D coverage covers most eligible prescription medications.

On the other hand, Medicare Advantage (Part C) programs offer vision, dental, and even fitness services besides the standard Medicare benefits. Consider getting a Part C plan if you anticipate frequent use of these services.

Who is Qualifies for Medicare Part B?

Generally, these people and groups are qualified for the Part B plan:

  • People over 65 years
  • People living with disability
  • Persons experiencing ESRD (end-stage renal disease)

A person must be eligible for premium-free Part A before being eligible for Part B when they first sign up for Medicare, says a Medicare specialist from Clearmatch Medicare. Often these people can get Part A for free and sign up for Part B when they first become eligible for Medicare. This is because most users spend Medicare taxes when they are working.

You can still sign up for Part B even if you need to buy Part A. You must, however, meet the following thresholds:

  • Be 65 and above
  • Be a United States citizen or have a legal permanent resident for five years or more in a row.

Cost of Medicare Part B Plan in 2022

Let’s now consider what Part B’s costs will cost you in 2022.

Monthly premium

Your monthly Part B premium is the cost of your Part B insurance. In 2022, the basic monthly premium for Medicare Part B is around $170.10.

People who make more money annually may be required to pay more each month. They use the tax return from the past two years to determine how much money you make each year.

Furthermore, a penalty for joining Medicare Part B after the deadline will impact the monthly premium. You’ll have to pay this if you fail to sign up for Part B immediately after qualifying.

When you have to pay the delayed registration penalty, the monthly premium will go up by up to 10% of the basic premium for every year you were qualified for Part B yet didn’t sign up. Provided you’re in Part B, you’ll have to pay this.

Deductibles

A deductible is a share you are liable to pay before Medicare begins paying for services under Part B. The Part B deductible in the year 2022 is $233.

Coinsurance

Coinsurance refers to the portion of a service’s total price that is your responsibility after your deductible has been met. In 2022, the coinsurance In the case of Medicare Part B, this figure is typically 20%.

Copays

A copay is the set amount you must pay in exchange for medical care. There are no usual copayments for Medicare Part B. In some scenarios, you will be asked to make such a payment. Consider the case of someone who uses the outpatient care of a hospital.

Out-of-pocket maximums

An annual out-of-pocket maximum establishes a ceiling on the amount you’ll have to pay for insured services. The total amount you’re responsible for paying is unlimited under Original Medicare.

When to enroll for a Medicare Part B Plan?

Some are guaranteed a spot in the original Medicare program, and some must take active steps to join.

Who is automatically enrolled?

People who meet specific criteria are enrolled in Medicare plan automatically. They include:

  • People eligible for a pension from the RRB (Railroad Retirement Board) or the SSA (Social Security Administration)
  • Persons under 65 years who are living with disability and have been receiving SSA or RRB disability benefits for at least two years
  • People who have ALS (amyotrophic lateral sclerosis) and are receiving disability benefits

Even if you are automatically enrolled, you do not have to take Part B if you don’t want to. If you’d like to put off doing Part B, you certainly can. This may be the case if you have coverage via your employer or spouse.

Who must sign up?

Remember that not all Medicare-eligible individuals can be automatically enrolled in the original Medicare. Some people must apply for Social Security benefits at a local SSA office.

  • Starting three months before reaching 65, those who will not receive retirement payments from the Social Security Administration or the Railroad Retirement Board may apply.
  • Sign-ups for ESRD patients can happen anytime, while the exact date of coverage initiation varies from person to person.

Bottom Line

Medically required outpatient care is covered under Medicare Part B, besides the many preventative care services. It was originally designed to be a part of the Medicare program.

Part B is available to those who are 65 and up, have a disability, or have end-stage renal disease. However, not all medical care is covered by Medicare Part B and must be paid separately.