What You Need To Know About Medicare Part B
Find Senior Living Near You:
- Part A (Hospital Insurance)
- Part B (Medical Insurance)
What Is Medicare Part B, and What Does It Cover?Medicare Part B helps cover medically necessary physician services. This would include your primary care doctor and most specialists’ office visits. Outpatient care, mental health services, home health services, durable medical equipment (DME), and many 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)
- Advance care planning
- Chronic care management services
- Eye exams related to prescription glasses or contacts
- Dentures or dental care
- Hearing aids and exams for fitting them
- Cosmetic surgery
- Long-term care
- Prescription medications
- Routine podiatry care
- Massage therapy
- Routine physical exams
Pro Tip: Don’t miss out on your hard-earned benefits! Our Medicare enrollment guide is a one-stop shop for all of your Medicare questions.
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 2021
|Expense type||Out-of-pocket cost||Additional details|
|Monthly premium||The standard Medicare Part B monthly premium for 2021 is $148.50.||If you receive Social Security or RRB benefits, your premium will be automatically deducted.|
|Annual deductible||The standard Medicare Part B annual deductible for 2021 is $203.||You must pay your annual deductible before Original Medicare Part B begins to pay for services.|
|Coinsurance||Part B enrollees pay approximately 20 percent of the Medicare-approved amount for all Part B services (after the annual deductible has been met).||Coinsurance, also known as cost sharing, is your required “share” of the cost for services.|
|Income-Related Monthly Adjustment Amount (IRMAA)||If your modified adjusted gross income is above a certain amount, you may pay an IRMAA in addition to your regular premium.||Medicare uses the modified adjusted gross income reported on your IRS tax return from two years ago.|
Medicare Part B Cost ExampleYou might be wondering, “How much exactly 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 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 $200. 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 2021 deductible of $203 before Medicare begins paying for services. For your $200 doctor visit on Jan. 12, Medicare pays $160. You are responsible for 20 percent of the total visit, so you will pay $40. In total, you will pay $243. This covers your 2021 deductible and 20 percent doctor visit. 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 EnrollmentYou can apply for Medicare Part B using one of the following methods.
OnlineThe Social Security Administration (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.
Inside tip: Follow our step-by-step My Social Security guide to set up your secure account.
By PhoneSSA customer service specialists are available Monday through Friday from 7 a.m. to 7 p.m. To speak with someone:
- 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.
Things to Consider When Enrolling in Medicare Part BAs 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 supplemental coverage 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.