What is Medicare Part B?

As you age, picking the best healthcare plan—Medicare or not—becomes even more critical. But finding a health plan that meets your unique demands and falls within your budget can also be a) time-consuming and b) challenging to manage. To ensure that everyone who qualifies for Medicare can discover the best plan for their needs, the Healthpilot team cuts through all the cumbersome information and provides a recommendation that’s tailored for your specific healthcare needs.
Keep reading for an easy, comprehensive guide to Medicare Part B from some experts who actually love the subject.

Medicare, both Parts A & B, make up what is typically referred to as Original or Traditional Medicare. Where Part A covers inpatient expenses, Medicare Part B covers medical services like doctors’ costs, outpatient care, and some preventative services. While Part B is optional, it covers certain things that Medicare Part A doesn’t, like lab tests and preventative screenings that help manage your health care.

The “parts,” otherwise known as the Medicare Alphabet, can be what makes Medicare confusing in the first place, but it’s the Parts of Medicare that make this government-run healthcare plan kind of genius. These various components, whether stand-alone or used in combination, provide you the freedom to create a coverage plan that best suits your needs and way of life.

Because there isn’t a simple “one-size-fits-all” answer to people’s health insurance needs, Healthpilot successfully untangled the complexities of the Medicare program. We provide you a recommended plan in just a few minutes, and if you choose to enroll, may be done in its entirety, quickly and, most importantly, securely, online.

While Medicare Part A is foundational to any Medicare program, there’s a reason Part B is also considered Original Medicare. Part B is thought of as the yin to Part A’s yang.

More Parts of Medicare

Medicare is a national health insurance program created and run by the United States federal government as a solution to increase the economic security of people that were traditionally underrepresented in the past. The Centers for Medicare and Medicaid Services (CMS) are in charge of Medicare, and the services are divided up into four main parts – A, B, C, and D.

Click the links below to learn more about each of the parts of Medicare:

Medicare Part A
Medicare Part B
Medicare Advantage (Part C)
Prescription Drug Plans (Part D)
Medigap (Medicare Supplement Insurance)

It’s likely you have heard of other parts of Medicare. To learn more about all of the different parts of Medicare, please visit the Healthpilot Medicare Basics page.

Medicare Basics page

Who is eligible for Medicare Part B?

Medicare Part B eligibility depends on whether you are already eligible for Medicare Part A. While you don’t have to have Part A to get Part B, if you do choose to purchase Medicare B without enrolling in Medicare Part A, the eligibility requirements are still the same. Just be aware that if you choose to delay Part B coverage because you already have credible coverage, that you have 8 months after that credible coverage ends to enroll in Part B before penalties kick in.

Original Medicare Eligibility and Enrollment

There are a few ways to find out if you qualify for Original Medicare (Medicare A and B) coverage or if you were perhaps automatically enrolled.

Prefer a simpler way? As one of the initial stages of joining Healthpilot, we make sure to verify your eligibility before we discover the best Medicare plan recommendation for you.

At age 65, if you receive benefits from Social Security or the Railroad Retirement Board (RBR), you will be auto-enrolled in Medicare Parts A and B (unless you live in Puerto Rico, you don’t automatically get Part B and must sign up for it). You will receive your red, white and blue Medicare card in the mail 3 months before your 65th birthday or the 25th month of receiving disability benefits. On the other hand, if you are not currently receiving Social Security benefits, you must actively enroll in Medicare. This election period in which you are eligible to sign up for Medicare is called the Initial Enrollment Period (IEP).

How do I get in touch with Social Security?

While it is Medicare that covers you, you have to sign up for it through Social Security Administration (SSA). This is because the SSA manages some eligibility requirements on behalf of Medicare, such as if you’ve paid Medicare taxes long enough to get Part A for free. (They also handle applications to join Medicare Part B.)

Signing up is easy. You can do it online at Social Security. It’s the easiest and quickest way to sign up and get help if you need it. Or if you prefer the phone, just call 1-800-772-1213 to talk to Social Security. (TTY: 1-800-325-0778).

If you or your spouse worked for a railroad, call the Railroad Retirement Board at 1-877-772-5772. (TTY: 1-312-751-4701).

We know. A lot, right? Don’t worry. While the following can read a bit like a word problem for the period when you will want to contact Social Security. We included an easy visual aid to show just how simple it really is. Your IEP to file for Medicare starts 3 months before you turn 65, during the month you turn 65, and up to 3 months after your 65th birthday. More of a visual person? Please see the visual aid below to better understand.

It is also possible to qualify for Medicare Part A and Part B before you are 65 if:

• You have a qualifying medical condition
• A doctor has diagnosed you with a condition that qualifies as a disability that prevents you from working

Medicare Part B Enrollment

If you have looked into anything to do with Medicare enrollment, then you have undoubtedly heard of your Initial Enrollment Period (outlined above) but did you know that it is possible for people who receive Medicare Part A to delay Part B? To delay Part B coverage, one of the following factors must apply to you to avoid paying a late enrollment penalty:

• Currently have employer or union coverage through your own or your spouse’s job
• Have COBRA coverage
• Are receiving Social Security disability benefits
• Have health care benefits from Veterans Affairs
• Have Tricare coverage as an active-duty service member or active-duty family member
• Currently receiving retiree health coverage

If you don’t qualify through an above scenario to delay Part B, you will need to enroll during your Initial Enrollment Period to avoid paying any sort of penalty. However, if you do end up waiting until the Annual Election Period (AEP), please note that it starts on October 15 and only runs until December 7, not leaving much time to do research, determine your eligibility, compare and decide on the perfect Medicare plan for you.

Unless you turn to Healthpilot. Once you are properly enrolled in your Original Medicare plan, we do the rest of the work, so you don’t have to. And you won’t find anyone who can do it all like Healthpilot does.

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What does Medicare Part B cover?

Often when you Google this, you will read that “Medicare Part B covers 80% of the Medicare-approved costs of certain services”, but what does that mean? Becoming familiar with what each area of your Medicare plan covers will ensure you not only find the finest coverage for yourself but it will also hopefully deter billing surprises later.

Medicare Part B has two distinct types of coverage, and these include preventative services and those that are medically necessary.

Preventative services include things like:

• Vaccines
• Annual cancer screenings
• Yearly “wellness” visits
• Lab work
• Mental health counseling

Medically necessary can mean something different depending on the patient, is defined as healthcare services or supplies needed to diagnose or treat an illness, injury, condition, disease or symptoms that meet the accepted standards of Medicine. Let us break it down for you, the following outpatient services that you may receive are examples of common Medicare B coverages:

• Doctors service and mental health services
• Outpatient Care or Surgeries
• Home health services
• Durable Medical Equipment
• Diagnostic imaging
• Chemotherapy
• Dialysis

Also, for any medications that are given to you while at the hospital, Medicare Part B will cover those as long as you are still considered an outpatient. While most medications are covered under Part D (more on that later), Part B will also cover some medications (such as injections provided in a doctor’s office), certain oral anti-cancer drugs, drugs used with some types of durable medical equipment and immunosuppressant drugs.

What does Medicare Part B not cover?

Medicare Part B was written to cover treatments considered medically necessary and/or preventative. While Medicare Part B walks hand in hand with Medicare Part A, it is important to know what isn’t covered to avoid any unexpected out-of-pocket costs. These include but are not limited too:

• Most dental care
• Cosmetic surgery
• Eye exams for prescription glasses
• Hearing aids and exams for fitting them
• Prescription drug coverage

You can see, it is important to know exactly what you currently want but also to consider what you may need in the near future from your healthcare plan. Make a list of those wants and needs, medications, physician information, and so on, so you can make sure you know which parts of each Medicare plan cover exactly what you require or what you may end up having to pay out-of-pocket for. Sound like a lot of work? It doesn’t have to be. You can see your recommended plan and even check eligibility and enroll in minutes with Healthpilot.

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What is the cost for Medicare Part B?

Medicare Part B premiums

Medicare Part B has a set monthly premium once you are enrolled. For 2023, the standard Medicare Part B premium is $164.90 each month, but your personal premium may differ because it is based on your income bracket and the Income Related Monthly Adjustment Amount (IRMAA). Some individuals may be able to get help from their state to pay for Medicare costs depending on certain conditions.

If you are currently receiving Social Security or Railroad Retirement Board (RRB) benefits, then your premium is likely being automatically withheld from your monthly Social Security check. If you aren’t or won’t be receiving Social Security benefits at the time of your Medicare enrollment, your bill will be mailed to you monthly instead.

Medicare Part B deductibles

In 2023, Medicare Part B’s deductible is $226. Once that is met, Medicare will cover 80% of your Medicare Part B expenses. Here is where the 20% coinsurance comes in as your out-of-pocket responsibility. There are other Medicare plans, such as Medicare Supplement (or Medigap) plans, that can be added to help lower these out-of-pocket costs (you can learn more about those plans here).

There is also an additional Medicare Savings Program that your income may qualify for if you are dual-eligible. This means you have both federal Medicare coverage and qualify for your state Medicaid program. These Medicare Savings Programs may pay some or even all of your Medicare Part B premium, deductibles, coinsurance and copays and are certainly worth checking out.

Ready to see your recommended Medicare plan?

High five! You did it. Selecting a Medicare plan or revising your existing plan coverage can be a bit stressful or just a snooze. But good for you because decisions involving your health, especially the future of your healthcare and related finances, are important and shouldn’t be taken lightly. However, you are also choosing a plan for just the next 12 months or less. If you find you need to make some changes, you can update your Medicare plan during the next Medicare AEP.

We at Healthpilot are aware of how challenging and confusing it may be to decipher all of the various components of Medicare. Work smart, not hard, and let us take care of everything for you. Once you take the first step by enrolling in your Original Medicare plan, then just tell us a bit about yourself. We then sort through the information to determine which plan to recommend to you. Healthpilot even made it simple to enroll in your recommended plan online. The best part is that we will continue to keep you in the know about any changes to your plan every year for the rest of your life once you become a Healthpilot customer.

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Let us help you find your Medicare plan

Medicare doesn’t have to be another thing you have to worry about. Once we work together to know your healthcare needs, Healthpilot’s patented technology will tailor a plan recommendation for you where you can enroll online in minutes.

In order to make sure your plan is offering the best protection for your needs or saving you money, we take into consideration changes to insurance policies as well as any adjustments to your health profile. You won’t need to be concerned about your Medicare coverage again. Doesn’t that sound great? Why yes, yes it does.

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