Medicare Part B Explained
Outpatient medical coverage for medically necessary healthcare services.
What Does Medicare Part B Cover?
Medicare Part B coverage provides you access to a variety of outpatient medical services. Part B covers preventive care including flu shots, colonoscopies, mammograms, and more. It covers ordinary outpatient things like doctor’s visits, lab testing, home health care, ambulance rides, and some chiropractic care.
However, Medicare Part B also covers services that sometimes occur in the hospital. This includes things like physician’s services, radiation or chemotherapy for cancer, surgeries, diagnostic imaging, medical equipment, and even dialysis for failing kidneys. Part B will also pay for drugs administered in a clinical setting, such as osteoporosis injections, infused drugs, antigens, and insulin that is used with an insulin pump. Otherwise, outpatient drugs fall under Part D. Part B is optional, but if Medicare is your primary coverage, you definitely need Part B. You also cannot get Medigap supplemental coverage without it.
How Much Will I Pay for Medicare Part B?
You must pay a monthly premium for your Medicare Part B benefits. The majority of Americans will pay the standard monthly amount set by the government. In 2022, the base rate for Part B is $170.10/month for people new to Medicare. However, you may owe more if your income is above a certain level.
If you enroll late into Part B, you may also have to pay a penalty for life. It’s important not to miss your enrollment window whenever you retire and lose access to your employer group health insurance.
Medicare will deduct your Part B premiums from your Social Security check if you are already enrolled in your SS income benefits. If not, they will bill you quarterly. There is a credit card option at the bottom of the quarterly invoices. To pay for Part B by credit card, just complete the bottom portion of the payment coupon and mail it to the Medicare Premium Collection Center.
You also have the option to use Medicare Easy Pay, a free auto-draft service that will deduct your premium payments monthly from a checking or savings account.
What Doesn’t Part B Cover?
Part B does not cover hospital expenses covered by Part A. It also does not cover cosmetic procedures, routine dental, vision or hearing, or routine foot care. It also does not cover drugs that you pick up yourself at a retail pharmacy. For those, you will need a Part D drug plan.
In general, Part B doesn’t cover things that are not reasonable and necessary. Your doctor usually will know the rules for what is covered and what isn’t.
What is my Cost Sharing Under Medicare Part B?
You will pay a percentage of the costs of your medically necessary Part B services. Generally, these costs are:
the annual Part B deductible ($233 in 2022)
20% of the remaining costs, with no limits or cap
any excess charges that a provider or facility may charge beyond what Medicare reimburses
What is most significant is the 20% that you will owe for outpatient medical care. For services like surgeries or chemotherapy, your expenses can add up to thousands of dollars. There is no reason for you to be subject to these expenses when there are supplemental coverage options available for any budget.
What is the Medicare Part B Late Enrollment Penalty?
If you failed to sign up for Medicare when you were first eligible, and you didn’t have any creditable coverage, you will be subject to the Medicare Part B late enrollment penalty. This penalty is equal to 10% per year for every year (12 full months) that you waited to enroll. This penalty gets applied against the standard Part B premium, which in 2022 will be $170.10.
If you enrolled late because you’ve had employer group health coverage from a company with 20 or more employees, you will not be subject to the Part B late enrollment penalty. When you leave that coverage, you have 8 months to sign up for Part B. This is your Special Enrollment Period for Medicare.