What You Need To Know About Medicare Part B

Medicare certainly plays a starring role in our older adult years! Medicare Part B enrollment can go hand-in-hand with major life changes like retirement, housing, and a reduction in finances. If you or a loved one is preparing to enroll in Medicare Part B, know that signing up doesn’t have to be complicated if you’re armed with the right information and resources. This guide will fill you in on the sign-up process, provide the latest costs, and go over what Medicare Part B covers (and what it doesn’t). Let’s get started!

Anyone who is eligible for Medicare Part A can enroll in Medicare Part B. In most circumstances, you are enrolled in Medicare Part A when you reach age 65 and enroll in Part B at the same time. If you’re still planning for retirement, you may wait to enroll in Medicare Part B when you are no longer going to be covered by employer insurance. Keep a close eye on your open enrollment dates, as there is a late enrollment penalty for Part B!

If this is the year you or a loved one turn 65, a Medicare & You handbook will arrive by mail. This is the official, annual Medicare handbook that is sent every September to every Medicare household ahead of the October annual enrollment period. This handbook summarizes your benefits and rights under Medicare, identifies the changes that will take place in January of the following year, and provides official definitions for many important terms that you will need to understand. You can access the current year’s handbook electronically at any time by logging into your Medicare account.

The following information is applicable to most Medicare enrollees. However, there are special circumstances that affect how and when Medicare begins for a recipient. These circumstances could include receiving disability benefits from Social Security or the RailRoad Retirement Board.1 (RRB) for at least 25 months, receiving disability benefits for ALS, or have End-Stage Renal Failure (ESRD).

Original Medicare consists of two parts:

• Part A (Hospital Insurance)
• Part B (Medical Insurance)

What Is Medicare Part B, and What Does It Cover?

Medicare Part B covers two types of services, medically necessary and preventative.

• Medically necessary: Services or supplies that are needed to diagnose and treat medical conditions that meet accepted standards of medical practice.
• Preventative: Service to help prevent illness or detect it at an early stage when treatment is more likely to perform well.

This would include your primary care doctor and most specialists’ office visits. Other things such as clinical research, ambulance services, mental health services, limited outpatient prescription drugs, outpatient care, home health services, durable medical equipment (DME), and other  preventive services are covered under Part B.2

Part B also covers:

• Screening mammograms to check for breast cancer
• Comprehensive cardiac rehabilitation (when certain conditions are met)
• Colorectal cancer screenings
• Diabetes screening (if your doctor determines a risk)
• Chemotherapy
• CPAP
• Advance care planning
• Chronic care management services

Part B does not cover:

• Eye exams related to prescription glasses or contacts
• Dentures and most dental care
• Hearing aids and exams for fitting them
• Cosmetic surgery
• Long-term care
• Most prescription medications
• Routine podiatry care
• Massage therapy
• Routine physical exams
• Concierge care

What Is the Cost of Medicare Part B?

Medicare Part B recipients must pay a standard monthly premium, meet their annual deductible, and pay a coinsurance for services rendered.3

Medicare Part B Costs for 2024

Medicare Part B Cost Example

You might be wondering, “Exactly how much will I pay out of pocket when I visit the doctor?” The actual dollar amount of a service Medicare Part B will cover depends on whether or not your physician accepts the assignment. This means your doctor/provider agrees to accept the Medicare-approved amount as full payment for the service they render. Sometimes, this is referred to as participating in or with Medicare.

A non-participating provider may require you to pay the entire charge for a service at the time you receive it; they can also charge you more than the Medicare-approved amount.

If your doctor has an agreement with Medicare to pay the Medicare-approved amount for the service, you will not be billed any more than the deductible and coinsurance.

For example, let’s say you visit your Medicare-approved physician for an outpatient cardiovascular appointment on Jan. 12. This appointment falls under your Medicare Part B insurance, and the visit is $250.

This was your first medical appointment of the year, so you have not yet paid your annual Medicare Part B deductible. You are responsible for the 2023 deductible of $226 before Medicare begins paying for services.

This means you have to pay the majority out of pocket for your doctor’s visit on Jan. 12. Of the $250 visit, you’ll pay 230.80. This covers your 2023 deductible and 20 percent of the remaining doctor visit balance. When you return for a follow-up visit in two weeks, you will only be responsible for the 20 percent coinsurance, since your deductible has already been paid.

Medicare regularly sends you a Medicare Summary Notice for Part B (Medical Insurance), which notifies you of claims processed, how much of your deductible you have already paid, what services Medicare was billed on your behalf, what they paid, and the amount you are required to pay.

Medicare Part B Enrollment

You can apply for Medicare Part B using one of the following methods.

Online

The Social Security Administration5 (SSA) manages your Medicare application and enrollment.

• Get started by visiting the Social Security Administration’s website.
• Create a “my Social Security” account.
• Start your Medicare application by selecting the Apply for Medicare Only button.

By Phone

SSA customer service specialists are available Monday through Friday from 7 a.m. to 7 p.m. To speak with a representative:

• Call the SSA’s toll-free number at 800-772-1213.
• If you have hearing loss, call the toll-free TTY number at 800-325-0778.

RailRoad Retirement Board

If you or your spouse worked for a railroad, call the RRB at 1-877-772-5772.

Things to Consider When Enrolling in Medicare Part B

As you prepare for Medicare enrollment, it’s important to think about the big picture. Take time to consider these four key questions:

• Do your current physicians accept Medicare? If they don’t, are there other medical professionals in the area who provide similar coverage?
• Do you plan to sign up for additional coverage from private insurers for prescription, vision, and dental needs?
• How will you budget for the Medicare Part B annual deductible, monthly premiums, and copayments?
• Do you need assistance paying for Medicare? Our Medicare Saving Programs guide explains how to get help.

Are you taking full advantage of your Medicare benefits? Whether you’re a first-time Medicare recipient or someone who’s been enrolled for years, understanding the finer points of Medicare can be confusing, which is why we are here to help. Watch the video with our Editor-in-Chief, Jeff Hoyt, to find out how to optimize coverage while lowering costs.