Medicare Part B: The BasicsPosted by Medicare Made Clear
Many people new to Medicare don’t know a lot about Part B. We’re here to help you learn the Part B basics.
Medicare Part B is medical insurance. It is one part of what’s called “Original Medicare.” The other part is Medicare Part A. Part A is hospital insurance.
Who can get Medicare Part B?
Eligibility for Part B is the same as for Medicare overall. You must be a U.S. citizen or legal resident living in the U.S. for at least five years in a row. You must also meet one of the following conditions:
- You are age 65 or older.
- You are under age 65 and have a qualifying disabilityA medical or physical condition that has lasted, or is expected to last, more than 12 calendar months and that prevents you from working..
- You are any age and have End Stage Renal Disease (ESRD)Permanent kidney failure requiring dialysis or a kidney transplant.
What does Medicare Part B cover?
Medicare Part B helps pay for doctor visits and other services you receive on an outpatient basis.
Services and items usually covered by Part B include:
- Outpatient medical services
- Some preventive care (such as flu shots)
- Some clinical laboratory services
- Some diagnostic screenings
- Ambulatory surgery center services
- Emergency room services
- Medical equipment including wheel chairs and oxygen
- Outpatient mental healthcare
- A few prescription drugs administered by a doctor, like chemotherapy
What does Medicare Part B cost?
Medicare Part B comes with some costs. These may include a monthly premium, deductibles, co-pays and co-insurance.
The Part B premium ranges from $104.90 to $389.80 per month in 2016. The amount you will pay depends on when you joined Medicare and on your income. Part B premium payments may be automatically deducted from your Social Security check.
Medicare Part B also charges an annual deductible. The deductible is $166 in 2016. After you pay the deductible, you are usually responsible for paying 20% of the Medicare-approved amount for most covered services you receive. This is called co-insurance.
How do I enroll in Medicare Part B?
All individuals who already receive Social Security benefits are automatically enrolled in Original Medicare (Parts A and B) when they reach the age of 65. People turning 65 who are not collecting Social Security need to enroll themselves during their Initial Enrollment Period.
Some people who have other coverage, such as employer health insurance, may choose to delay Part B enrollment and save on paying the premium. It’s a good idea to talk with your plan benefits manager about how your plan might work with Medicare.
People on disability are automatically enrolled in Original Medicare (Parts A and B) after receiving Social Security Disability Income (SSDI) for 24 months. Get more information about enrolling in Medicare due to disability.
If you have Lou Gehrig’s Disease (ALS), you are automatically enrolled in Original Medicare (Parts A and B) the first month you start to receive SSDI.
People with ESRD three months after dialysis begins or after a kidney transplant. Contact Social Security at 1-800-772-1213, TTY 1-800-325-0778, 7 a.m. to 7 p.m. local time, Monday through Friday for more information.
Know the basics before you enroll in Medicare. If you need help, contact your State Health Insurance Assistance Program (SHIP) for free counseling services.
For more information, explore MedicareMadeClear.com or contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048.
Medicare 2016 Costs at a Glance, Medicare.gov, February 19, 2016