Medicare Part B

What is Medicare Part B?

Medicare Part B is one of the two parts of Original Medicare and provides medical coverage. Beneficiaries who are eligible for Medicare Part A are also eligible for enrollment in Part B once they are entitled to Part A. Medicare Part B is a voluntary program which requires the payment of a monthly premium for all months of coverage.

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What does Part B cover?

How do I find out if Medicare covers what I need?

  • Talk to your doctor or other health care provider about why you need certain services or supplies. Ask if Medicare will cover them. You may need something that’s usually covered but your provider thinks that Medicare won’t cover it in your situation. If so, you’ll have to read and sign a notice. The notice says that you may have to pay for the item, service, or supply.
  • Find out if Medicare covers your item, service, or supply.

What factors determine Medicare coverage?

  • Federal and state laws.
  • National coverage decisions made by Medicare about whether something is covered.
  • Local coverage decisions made by companies in each state that process claims for Medicare. These companies decide whether something is medically necessary and should be covered in their area.

What's not covered by Part B?

  • Most dental care
  • Eye exams related to prescribing glasses
  • Dentures
  • Cosmetic surgery
  • Massage therapy
  • Routine physical exams
  • Acupuncture
  • Hearing aids and exams for fitting them
  • Long-term care
  • Concierge care

What does Part B cost?

Part B Premiums

The standard Part B premium amount in 2020 is $144.60, and most people will pay this amount. However, if your modified adjusted gross income is above a certain threshold, you may pay an Income Related Monthly Adjustment Amount (IRMAA).

Your Part B premium will be automatically deducted from your benefit payment if you get benefits from one of the following:

  • Social Security
  • Railroad Retirement Board
  • Office of Personnel Management

If you do not receive one of these benefit payments, you’ll receive a quarterly bill for your Medicare Part B premium. 

Late Enrollment Penalty

If you didn’t get Part B when you were first eligible your monthly premium may go up 10% for each 12-month period you could’ve had Part B but didn’t sign up. In most cases you’ll have to pay this penalty each time you pay your premiums for as long as you have Part B.

Part B Deductible & Coinsurance

In 2020 you will pay $198 for your Part B deductible. After you meet your deductible for the year you typically pay 20% coinsurance of the Medicare-approved amount for the following approved services:

  • Most doctor services (including while you’re a hospital inpatient)
  • Outpatient therapy
  • Durable medical equipment (DME)

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