Medicare Part B

Medicare Part B is a federal health insurance program supplementary to Part A. This voluntary program requires a premium and covers physician and outpatient services. Here's a look at the Part B basics.

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Medicare Part B covers medically-necessary services and some preventive services that are not covered by Medicare Part A. If you enroll in Part B, Medicare will pay 80% of the “reasonable charge” for covered services after you’ve met the deductible for that year. You are responsible for paying the other 20% (co-insurance). Medicare has a defined “reasonable charge” for services that might be less than what the doctor charges. In that case, you’ll be responsible for paying 20% plus the difference between the actual cost of service and Medicare’s reimbursement. Some doctors may accept assignment, meaning they’ll only charge Medicare’s “reasonable charge” for services, leaving you to pay the 20% co-insurance.

Who Can Receive Medicare Part B?

You can receive Medicare Part B if you are a U.S. citizen and:

  • You are over 65, or
  • You are under 65 and have certain disabilities, or
  • You have End-Stage Renal Disease

How Much Does Part B Cost?

You are responsible for paying the Part B premium every month. The standard premium for 2009 is $96.40. You may have to pay a higher premium based on your income if you file single on your tax return and your modified adjusted gross income (MAGI) is higher than $85,000. For married filing jointly, the MAGI limit is $170,000. Individuals and couples who exceed the minimum income limits could pay as much as $308.30 a month.

If you don’t sign up for Part B when you are first eligible for it, your premium could be 10% higher for that 12-month period.

In 2009, you must meet a $135 deductible before Medicare will begin paying its share of coverage.

Part B Automatic Enrollment

If you receive Social Security or Retired Railroad Board (RRB) benefits, you will automatically receive Part B on the first day of the month you turn 65. Your Medicare card will come in the mail 3 months before your 65th birthday. If you are under 65, you will receive Part B after you’ve received disability benefits from Social Security or RRB for 24 months. Your Medicare card will come in the mail on the 25th month of your disability.

Though you are automatically enrolled in Part B under the previously mentioned circumstances, you don’t have to keep it. If you don’t want Part B, your card will come with instructions on cancelling it. Follow those instructions and send the card back. If you keep the card, you will pay Medicare part B premiums. Premiums are automatically deducted from your Social Security or RRB benefits.

How to Sign Up for Medicare Part B

If you would like to receive Part B, but you’re not receiving Social Security or RRB benefits, you can sign up during the initial enrollment period which starts 3 months before the month you turn 65 and ends 3 months after you turn 65.

You can also sign up for Part B during the general enrollment period from January 1 to March 31 each year and your coverage will begin on July 1 of that year. Note, if you missed the signup during your initial enrollment period, you could face a 10% increase in your monthly premium.

There are special enrollment periods for those who waited to sign up for Medicare because they had group health insurance or health insurance while serving as an international volunteer. You can sign for Part B any time that you or your spouse has group plan coverage from an employer. You can also sign up a maximum of 8 months after employment ends or group health plan
coverage ends, whichever is first. International volunteers can sign up a maximum of 6 months after the volunteer assignment ends.

What Services Does Part B Cover

  • Part B services include, but are not limited to:
  • Doctor services that are medically necessary
  • Emergency ambulance services and some non-emergency transportation under doctors orders
  • Fees for approved ambulatory surgical centers
  • Blood
  • Some preventative services
  • Clinical laboratory services
  • Qualifying clinical research studies
  • Some cancer screenings
  • Defibrillator for those diagnosed with heart failure
  • Diabetes screenings for those with certain risk factors, diabetes self-management supplies, eye exams for people with diabetes, foot treatment
  • Certain medical equipment (e.g. oxygen equipment and supplies) ordered by your doctor for use in your home
  • Emergency room services
  • Eyeglasses after cataract surgery
  • Outpatient primary care and preventive in a federally-qualified health center
  • Flu shots
  • Hearing and balance exams as ordered by your doctor
  • Certain vaccinations and screenings for those with risk factors
  • Mental health care
  • Occupational therapy
  • Pap tests, pelvic exams, and clinical breast exams
  • Physical therapy
  • Certain prescription drugs
  • Speech pathology services
  • Surgical dressing services
  • Urgent care

You can find out more about Medicare Part B by contacting your local Social Security office or by visiting the Medicare website www.medicare.gov.

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