By: Eligibility Team | August 22, 2019

Medicare Part B is probably the most regularly used Medicare coverage, and it, along with Part A, makes up Original Medicare. In a nutshell, Part B covers most regular health care expenses, including doctor visits, lab work, and durable medical equipment—but only if you receive these services as an outpatient.

If a doctor admits you into a hospital, Medicare Part A  takes over coverage of many services that Part B would otherwise cover. Learn more about Medicare Part A vs. Part B.

If you’re not ready to dive into Part B yet, take a step back and learn about the Medicare program more generally with our Ultimate Guide to Medicare. Otherwise, onward we go.

What does Medicare Part B cover?

Medicare Part B is considered medical insurance and covers mostly routine and outpatient care. That’s in contrast to hospital insurance (Part A) which takes over if you’re admitted into a hospital or in a few other circumstances.

How much Part B pays out for your care may depend on whether the Medicare program classifies care as a medically necessary or preventative service. Annual wellness checks typically cost nothing, for example, but visiting your doctor because you’re sick will likely come with a copay.

Part B covers the following services:

  • Doctor visits, both Primary Care Physicians (PCPs) and specialists
  • Mental health visits, including family counseling, therapy, and depression screening
  • Lab testing, such as medically necessary blood work
  • Emergency and ambulance services
  • Durable medical equipment, such as wheelchairs and medical braces
  • Some medications, such as shots administered at the doctor’s office

Unfortunately, Part B doesn’t pay for many of the services typically covered by employer-sponsored health insurance plans.

Medicare Part B does not cover the following:

  • Most dental care and dentures
  • Hearing aids and exams
  • Eye exams related to eyeglass and contact prescriptions
  • Most prescription drugs
  • Cosmetic surgery
  • Acupuncture

If you want these services, don’t worry. Many Medicare Advantage plans include such services in addition to everything covered by Part A and Part B. Another option is adding a standalone Part D plan to cover your medications.

What does Medicare Part B cost?

In 2019, Medicare Part B has an annual deductible of $185, which you’ll need to pay out of pocket before your coverage kicks in. Most people pay the standard premium of $135.50 in 2019.1 If your income is higher than $85,000 (or $170,000 for married couples who file their taxes jointly), you may pay a higher premium.

2019 Medicare Part B premiums by income

Individual incomeMarried income (filed jointly)Married income (filed separately)Monthly premium
$85K or less$170K or less$85K or less$135.50 (standard premium)
$85,001–$107,000 $170,001–$214,000N/A$189.60
$107,001–$133,500$214,001–$267,000N/A$270.90
$133,501–$160,000$267,001–$320,000N/A$352.20
$160,001–$499,999$320,001–$750,000$85,001–$415,999$433.40
$500K or more$750K or more$415K or more$460.50

Based on Medicare.gov. Data effective 5/23/19.

Keep in mind that even if your Part B premium is based on your income as a married person, you and your spouse will each pay a separate premium when you’re both covered by Medicare. Medicare doesn’t offer couples or family coverage, like employer-sponsored health insurance does.

Am I eligible for Medicare Part B?

Medicare beneficiaries qualify for Part B when they have either:

  • Turned 65
  • Reached their 25th month on disability
  • Started dialysis treatment for end-stage renal disease (ESRD)
  • Received an amyotrophic lateral sclerosis (ALS) diagnosis

To be eligible for Part B, you’ll also need to meet residency and citizenship requirements and stay up to date on your premiums. Learn more about Part B eligibility requirements.

In addition to having its own eligibility requirements, Part B itself is an eligibility requirement for other parts of the Medicare program. To enroll in a Medicare Advantage, Medicare Supplement (Medigap), or Part D prescription drug plan, you must first have Part B—and sometimes Part A as well. In that sense, Medicare Part B acts as a gateway to other parts of Medicare.

If you’re newly eligible, read our guide on getting started with Medicare.

How do I apply for Medicare Part B?

You might expect to contact the Centers for Medicare & Medicaid Services (CMS) to apply for Medicare coverage, but people enrolling in Part B for the first time must instead apply through the Social Security Administration (SSA). You can do so in three ways:

  • Online via SSA.gov
  • By phone at 1-800-772-1213 from 7 a.m. to 7 p.m. in your time zone
  • In person at your local SSA office

Learn more about how to apply for Medicare.

When should I enroll in Part B?

The best time to enroll in Part B is during your Initial Enrollment Period (IEP) This seven-month timeframe starts three months before the month you’re eligible to receive Medicare.

You can also enroll during the fall Open Enrollment Period or Special Enrollment Period. Learn more about all Medicare enrollment periods.

If you already receive Social Security retirement or Railroad Retirement Board (RRN) benefits when you become eligible, the government may enroll you in Part B automatically.

Learn more about 2019 Medicare eligibility.

Do I need to enroll in other parts of Medicare?

Part B probably doesn’t cover all your health care needs. It’s just half of Original Medicare, after all. Part B coverage also comes with additional costs such as a deductible, copayments, and coinsurance.

To help cover more of your health care expenses, consider adding other parts of Medicare:

  • Part A (hospital insurance)
  • Part D (prescription drug coverage)
  • Medicare Supplement (Medigap)

You may also be eligible for Medicaid, a state-administered health care program. Learn more about Medicare vs. Medicaid.

What if I don’t want Part B?

Many people already have health coverage when they become eligible for Medicare and want to keep their current coverage. Many of them also want to delay enrolling in Part B to avoid paying premiums for double coverage.

It makes sense, right? Just know that waiting to enroll in Part B can earn you a Late Enrollment Penalty (LEP) unless you have creditable (as good as Medicare or better) coverage from a plan sponsored by a qualified employer.

Caution

Some employer-sponsored health plans require beneficiaries to enroll in Medicare, making the insurer a secondary payer for any claims you make. Meanwhile, it’s illegal to have other plans—like Health Savings Accounts—simultaneously with Medicare. If you’re not sure whether your current coverage requires or conflicts with Medicare, call the number below to speak with a registered insurance agent.

Declining Part B altogether

If you don’t think you’ll ever want Part B, you don’t have to enroll, whether you have creditable coverage from another source or not. But if you change your mind later, you may pay a hefty Late Enrollment Penalty.

If the government automatically enrolls you in Part B, declining coverage is a little more complicated. You’ll have to actively seek out a representative from the Social Security Administration by phone or in person.

The alternative to Part B

If you’re looking for a single health plan that covers everything Original Medicare covers and then some, consider Medicare Advantage. Many plans come with drug, dental, hearing, and vision benefits—plus extras like the SilverSneakers program. You won’t have to juggle multiple health plans. Plus, many Advantage plans have low or $0 premiums (in addition to the part B premium).

In short, Medicare Advantage is a lot like the employer-sponsored health insurance you may have had for many years, and you can switch to an Advantage plan even if you’re already enrolled in Medicare Part B.

Learn more about the differences between Original Medicare and Medicare Advantage.

Final thoughts: Part B may not be right for you

Medicare Part B covers doctors visits, lab work, and durable medical equipment. It’s a way to have most of your regular health care expenses covered with any provider that accepts Medicare.

Still, standalone Part B isn’t everyone’s cup of tea. It doesn’t cover things other types of health plans include, such as hearing, dental, and vision benefits. And if you want hospital insurance or drug coverage, you’ll also need to enroll in Part A or Part D.

A licensed sales agent can help you sort through your options and find the choices that may work best for you. To speak with one, call  the number below.

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855-802-1206

Sources

  1. Medicare, “Medicare Costs at a Glance

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