There are four parts of Medicare. In general:

  • Part A = inpatient hospital coverage
  • Part B = outpatient medical coverage
  • Part C = an alternative benefit form to Original Medicare that offers extra benefits
  • Part D = prescription drug coverage

Today, we will be looking further into Medicare Part B.

What does Medicare Part B cover?

Medicare Part B coverage provides you access to outpatient medical services. Part B covers preventive care for services like 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 too.

Medicare Part B also covers more expensive services that sometimes occur in the hospital. Examples include: radiation or chemotherapy for cancer, surgeries, diagnostic imaging, medical equipment, and  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.

To break this down further:

  • Preventative services: Outpatient physical, speech, and occupational therapy services. Important to note, these are only covered as long as they are administered by a Medicare-certified therapist. 
  • Provider services: Services deemed “medically necessary.”
  • Durable medical equipment: Equipment that serves a medical purpose, able to withstand repeated use, and appropriate for use at home.
  • X-rays and lab tests: All doctor ordered x-rays and lab tests.
  • Home health services: If you are homebound and need skilled nursing or therapy care.
  • Ambulance services: Emergency transportation by ambulance. Important to note -limited coverage for non-emergency transportation is available if there is no safe alternative and it is medically necessary.
  • Chiropractic care: While this can be covered, it is only covered by Part B when medically necessary to fix subluxation of the spine.
  • Certain prescription drugs: Certain drugs such as immunosuppressants, select anti-cancer, select antiemetic, select dialysis, and other typical drugs administered by a physician.

To summarize, Medicare Part B covers two types of services:

  • Medically necessary services:Services or supplies needed to diagnose or treat your medical condition. Must meet accepted standards of medical practice.
  • Preventive services: Any health care to prevent illness or detect it at an early stage, when treatment is most likely to work best. 

What does Medicare Part B not cover?

In general, Part B doesn’t cover things that are not reasonable and necessary. Your doctor will typically know the rules for what is covered and what isn’t.

Part B does not cover hospital expenses, this is covered by Part A. It also doesn’t cover cosmetic procedures, routine dental, vision or hearing, or routine foot care. Finally, it doesn’t cover drugs you would pick up at a retail pharmacy. You will need a Part D drug plan for that.

Who is eligible for Medicare Part B?

The same eligibility requirements for Part A apply for Part B.

However, there is a monthly premium for Medicare Part B but this provides for your outpatient benefits such as doctor visits, labs, surgery fees, and more.

How do I enroll for Medicare Part B?

If you are already receiving Social Security benefits, you will automatically be enrolled in Medicare Part B. Your card will arrive in the mail by the month before your birthday.

If you do not receive Social Security benefits, you will need to enroll yourself.  This can be done online, on the phone, or in person at your local Social Security office. After you apply, it will take 2 – 3 weeks before your card will arrive, so you should plan to apply several weeks prior to when you will need the coverage.

It is also very important to note that if you fail to sign up for Medicare when you become eligible, and if 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 2020 will be $144.60.

So make sure you plan ahead and don’t delay!

When do I enroll for Medicare Part B?

If you turn 65 and are already receiving Social Security retirement benefits or benefits from the Railroad Retirement Board (RRB), enrollment in Medicare Part B is usually automatic. Medicare Part B benefits begin the first day of the month you turn 65. Your red, white, and blue Medicare card will arrive about three months before your 65th birthday.

2020 costs at a glance
Part B premium The standard Part B premium amount is $144.60 (or higher depending on your income).
Part B deductible and coinsurance $198. After your deductible is met, you typically pay 20% of the Medicare-approved amount for most doctor services (including most doctor services while you’re a hospital inpatient), outpatient therapy, and durable medical equipment (dme)