MedicareFAQ

Unboxing Medicare Part B (Coverage, Costs, & Enrolling)


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Maybe you're not quite sure when to enroll in Part B, or you're unfamiliar with the coverage and costs involved in Medicare's outpatient insurance. If so, this video is a must-watch as we're unboxing everything you need to know about Medicare Part B.

You'll use your Part B at doctors' offices, as it's your outpatient coverage. Part B covers medically necessary services given by a provider. This includes preventive care, surgeries, and other treatments.

Some medically necessary services Part B will cover include mammograms, colonoscopies, lab testing, durable medical equipment, occupational therapy, transplants, home health services, medications administered at the doctor's office, outpatient mental health services, ambulance services, vaccines (such as for the flu or Hepatitis B), and some services you receive in the hospital.

Moving on to Medicare costs, Part B comes with a monthly premium.  Each year, there is a standard premium amount that is adjusted if your income is higher. Each year, the Part B premium is subject to increase and the standard amount is announced each year in the late fall, as is the annual deductible for Part B.

In addition to the premium and deductible, Part B also involves coinsurance. Medicare pays 80% of the approved amount, leaving the beneficiary responsible for the remaining 20%. This means you'll need to pay 20% for all services received at the doctor's office.

Unfortunately, Part A and Part B don't have out-of-pocket maximums. So, the 20% you pay out-of-pocket can quickly add up. Luckily, this is where Medicare Supplement (Medigap) plans can help. They cover the 20% coinsurance, thus protecting you.

Last but not least, we're going to let you know when to enroll in Part B. The first enrollment window every Medicare beneficiary has to enroll in Part B is the initial enrollment period. It's unique to you and starts three months before your 65th birthday, ending three months after your 65th birthday. Thus, you have seven months to enroll in Part A and Part B. Keep in mind that if you don't enroll during the first three months of this period, your coverage could be delayed and won't become active until after you turn 65.

If you're collecting Social Security benefits, you'll automatically enroll in Original Medicare (Parts A and B), and your Part B premium will be deducted from your Social Security check each month. If you're not collecting Social Security, you'll have to enroll yourself. If you have another form of creditable coverage, like group medical insurance through a large employer, you can delay enrollment in Part B and avoid penalties.

Once you leave your employee group coverage when you retire, you'll get a Special Enrollment Period of eight months. Make sure to get the right documentation for proof of coverage.

Those who miss their Initial Enrollment Period and don't qualify for a Special Enrollment Period can use the General Enrollment Period to sign up for Part B. This enrollment period occurs annually, from January 1 through March 31. If you sign up during this time, your coverage will begin on July 1.

When you lack creditable coverage at the time of enrollment, you'll face a penalty of 10% for every 12 months you went without coverage. Unfortunately, this penalty will stick with you forever. This is why it's so important to be familiar with what constitutes creditable coverage and why you shouldn't just assume you don't need Part B yet.

Resources: https://www.medicarefaq.com/original-medicare/medicare-parts/medicare-part-b/

Our YouTube Channel: https://www.youtube.com/medicarefaq
Our Facebook Community: https://www.facebook.com/groups/medicarefaq

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