Medicare Part B Information & Cost
Medicare Part B is medical insurance. The standard monthly Medicare Part B cost is $135.50. Part B benefits have a deductible and coinsurance for services that are Medicare-approved. The annual Medicare Part B insurance deductible is $185. After the Part B deductible is met, the usual coinsurance for Medicare-approved services is 20%.
When to apply for Medicare Part B?
The best time to apply for Medicare Part B is during your initial enrollment period (IEP). Your initial enrollment period is a 7-month period that starts three months before your 65th birthday month, includes your 65th birthday month, and extends three months after.
Do I have to sign up for Part B?
It’s optional whether to sign up for Medicare Part B benefits. If you do not apply for Medicare Part B when you are first eligible, you may have to pay a late enrollment penalty. The monthly Medicare Part B penalty could increase 10% for each 12-month period that you could have the benefits, but didn’t sign up.
If you, or your spouse, continue working and are covered by the employer group health insurance plan, it may be best not to sign up for Medicare Part B.
Talk to your benefits administrator to see how the group insurance works with Medicare. The employer group coverage must be considered creditable coverage to avoid the Part B penalty.
What does Medicare Part B Cover?
Part B provides coverage for doctors, specialists, outpatient care, home health care, durable medical equipment (and other supplies), and preventive services.
Medicare Part B Coverage
- Ambulance Services – Part B covers emergency ground transportation, emergency air transportation, and non-emergency ambulance transportation in a medically necessary situation. Ambulance services cost is 20% and the deductible applies.
- Ambulatory Surgical Centers – Medicare Part B covers approved surgical procedures in an ambulatory surgical center. This is a facility where you won’t need more than 24 hours of care. The Ambulatory Surgical Centers cost is 20% and the Part B deductible applies. If the procedure is for certain preventive services, you pay nothing.
- Blood – Part A covers blood you get as a hospital inpatient while Medicare Part B covers blood you get as a hospital outpatient. If the provider has to purchase blood, you have to pay for the first 3 pints of blood unless you have the blood donated by you or someone else. There is a copay for the blood processing and handling services for every unit of blood received (Part B deductible applies).
- Blood Sugar Test Strips – Some diabetic test supplies, such as blood sugar test strips are covered by Part B. You are responsible for 20% of the Medicare-approved amount.
- Cardiac Rehabilitation Programs – Part B Medical insurance covers programs that include exercise, education and counseling. The cost is 20% and the deductible applies.
- Cataract Surgery – First, find out if the surgery is going to be performed in an inpatient or outpatient setting. If the cataract surgery is being performed inpatient, the Part A insurance is responsible. If the surgery is performed in an outpatient setting, Part B insurance pays. Next, ask the doctor, hospital, or facility how much you are responsible for paying and the the costs for any care you receive after. Following the cataract surgery, Part B helps pay for one pair of eyeglasses or contact lenses.
- Chemotherapy – Medicare covers chemotherapy for cancer patients. You are responsible for a copay in an outpatient hospital setting. You pay 20% and any Part B deductible for chemotherapy treatment in a doctor’s office or freestanding clinic.
- Chiropractic – Supplemental routine care is not covered. Part B does cover a manual manipulation of the spine to correct subluxation.
- Diagnostic Tests, X-Rays, and Lab Services – Your “B” benefits cover CT scans, MRI’s, EKG’s, X-rays, and PET scans when your doctor orders them for medical treatment.
- Dialysis – Medicare Part A will pay for dialysis if you are admitted into the hospital. Medicare Part B covers routine maintenance dialysis. Part B covers training for home dialysis and support services. Equipment for home dialysis equipment and supplies, wipes, machines, sterile drapes, rubber gloves, and scissors is also covered.
- Doctors – Medicare Part B covers services you receive from your doctor for medically necessary reasons. Other providers, such as physical therapists, speech language pathologists, psychologists, physician assistants, nurse practitioners, and clinical nurse specialists are also covered. After the $183 Part B deductible is met, you pay 20% for the Medicare-approved amount.
- Emergency Room – Medicare Part B covers visits to the emergency room. You pay a copay for each emergency visit and a copay for each hospital service. You also have to pay the 20% coinsurance as well as meeting the Part B deductible. If you are admitted into the hospital within 3 days of the emergency room visit, you will no longer have the copay.
- Preventive Services