What is Medicare Part B?

Medicare Part B is medical insurance that pays for health care services you receive as an outpatient. It also covers physician services both in and out of the hospital. Medicare Part B and Part A make up what is called Original Medicare.

What Does Medicare Part B Cover?

Medicare Part B medical insurance covers two categories of healthcare costs:

• Medically necessary: supplies and services required to treat a health condition.
• Preventive: services that prevent a health condition from developing or catch it while in its infancy.
  

Medically Necessary: ‍

Medicare Part B medically necessary services are subject to deductibles and coinsurance and include the following:

• Doctor visits
• Physical therapy (if requested by a doctor)
• Clinical laboratory services (blood and urine samples, for example)
• Ambulatory surgery center
• Diagnostic tests such as MRIs, CT scans, EKGs, and X-rays
• Durable medical equipment used at home (wheelchairs or walkers)
• Emergency room services
• Physician services while in the hospital
• Outpatient mental health care
• Periodic skilled nursing care for the homebound
• Ambulance services
• Cardiac rehab
• Certain oral and vision surgeries

Preventative Care:

‍Medicare Part B covers the following preventive care:

• Hepatitis B, flu, and pneumococcal shots
• Diabetes, cancer, and cardiovascular screenings
• Glaucoma tests
• Bone density measurements
• Colonoscopies
• Alcohol misuse and depression screenings
  

What is Not Covered?

It is important to remember that Medicare Part B does not cover all of your healthcare costs.

Medicare Part B does not cover:

• Outpatient prescription drugs
• Hearing exams or hearing aids
• Eyeglasses or routine vision exams
• Routine dental services, including dentures
• Routine foot care
• Long-term care
• Cosmetic procedures
• Acupuncture
• Medicare Part B excess charges
  

Part B Excess Charges

Medicare Part B excess charges might apply if a nonparticipating provider delivers your care. Under federal law, doctors who sign up with Medicare (accept assignment) cannot charge more than Medicare’s approved amount for a service. However, doctors who do not participate in Medicare can charge up to 15% more than the agreed rate. Medicare Part B does not cover this 15% excess charge, but enrolling in a Medicare Supplement Plan (Plan F or G) will cover it.

Who Qualifies for Medicare Part B?

If you qualify for premium-free Part A, you are eligible for Medicare Part B once you qualify for Part A.

If you pay a premium for Part A coverage, you must meet the following requirements to be eligible for Medicare Part B:

• Be 65 or older
• Be a U.S. resident
• Be either a U.S. citizen or a lawfully abiding U.S. resident for at least five continuous years

You are also eligible for Medicare Part B if you are under 65 and meet one of the following conditions:

• You are receiving disability benefits through SS or Railroad Retirement
• You have end-stage renal disease (ESRD)
• You have amyotrophic lateral disease (ALS or Lou Gehrig’s disease)

When Should I Enroll?

If you receive SS or Railroad Retirement benefits, you are automatically enrolled in Medicare Part B medical insurance.

If you are not automatically enrolled in Medicare Part B and have to sign up, your Initial Enrollment Period (IEP) is the best time to do so. Your seven-month IEP starts three months before your 65th birthday, includes your birthday month, and ends three months after you turn 65.

You can opt not to enroll in Medicare Part B when you are first eligible. However, if you wait to join after your IEP, you might face a penalty.

If you delay enrollment, you have two other times when you can enroll in Medicare Part B:

• General Enrollment Period (GEP). If you opt-out of Medicare Part B automatic enrollment or do not enroll during your IEP, you can join during the GEP. General enrollment runs from Jan. 1 through Mar. 31 of each year. You will pay a penalty for late enrollment; the penalty will be added to your Medicare Part B premium.
• Special Enrollment Period (SEP). Individuals who do not sign up for Medicare Part B during their IEP because they had coverage under a group plan through their employer (or spouse’s employer) can enroll during a SEP. The SEP is an eight-month period that starts when your employment (or your spouse’s) ends or your group coverage ends, whichever comes first. You will not be charged a late penalty if you sign up for Medicare Part B during a special enrollment period.

How Do I Enroll?

You can sign up during one of the enrollment periods by contacting the Social Security Administration in one of several ways:

• Online
• Over the phone (1-800-772-1213)
• At your local Social Security office
  

How Much Does it Cost?

You must pay a monthly premium for your Medicare Part B medical insurance. The federal government sets the Medicare Part B premiums and will automatically deduct the premium from your benefits check if you receive help from one of the following:

• Social Security
• Railroad Retirement
• Office of Personnel Management

If you do not receive any of these benefit checks, you will receive a quarterly bill. You can pay your Medicare Part B bill with a check or credit card. You can also pay your Medicare Part B premium through Medicare Easy Pay, a service that deducts your monthly premium from a savings or checking account.

Your premium amount is based on income. Most seniors pay the base rate. However, if your modified adjusted gross income (MAGI) is above a certain threshold, you will pay more for your Medicare Part B premiums.

Following are several examples breakdown of income ranges and their monthly premiums for 2024:

Total Monthly

Premium Amount: $174.70

• Less than or equal to $103,000
• Less than or equal to $206,000

Premium Amount: $244.60

• Greater than $103,000 and less than or equal to $129,000
• Greater than $206,000 and less than or equal to $258,000

Premium Amount: $349.40

• Greater than $129,000 and less than or equal to $161,000
• Greater than $258,000 and less than or equal to $322,000

Premium Amount: $454.20

• Greater than $161,000 and less than or equal to $193,000
• Greater than $322,000 and less than or equal to $386,000

Premium Amount: $559.00

• Greater than $193,000 and less than $500,000
• Greater than $386,000 and less than $750,000

Premium Amount: $594.00

• Greater than or equal to $500,000
• Greater than or equal to $750,000

The premiums continue with this pattern the higher an individuals MAGI is.

Are There Coverage Gaps?

Medicare Part B pays 80% of its approved rate for medically necessary services, not 100%. The remaining 20%, called Medicare Part B coinsurance, is your responsibility to pay.

You also have an annual Medicare Part B deductible that you must pay before Medicare Part B pays anything on your claims. In 2024, the Medicare Part B deductible was $240.

Unlike Part A, your Medicare Part B deductible is tied to a calendar year, not a benefit period. Therefore, your deductible starts over each year on Jan. 1.

The coverage gaps between the Medicare Part B payment and your Medicare Part B deductible and Medicare Part B coinsurance responsibility can add up quickly if you have a chronic health condition. Medicare Supplement Plans (Medigap plans) can help cover these expenses.

Article Resources:

What Part B Covers

Part B Excess Charges

Part B Eligibility

Ready to Learn More?

Our mission is to inform consumers of their options and help them navigate the plan selection process, and we are proud to work with some of America’s highest-rated insurance providers. Feel free to call our agency for a personalized insurance quote today!