Medicare Part B

Medicare part B is a component of Original Medicare (the other one being Part A), a federal insurance program run by the federal government. As people advance in age, they require more medical care than they did when they were young. At the same time, they may not want to drill holes in the pockets of their children or grandchildren, who will probably be trying to work their way towards financial stability.

Medicare partly solves this problem, and in this article, we will focus on Medicare Part B. We will explain what the program entails, how it works, and who is eligible. Once you finish reading this piece, you will be able to tell if you need to sign up for Medicare Part B or not.

What is Medicare Part B?

It is also called medical insurance. Basically, Medicare Part B covers costs for necessary medical care and supplies that you get outside a hospital. Although it’s managed by the federal government, some aspects of Medicare are also run by private insurance companies, although they have to follow regulations set out by Medicare. Some of the top Medicare provider companies in California are Aetna, Anthem Blue Cross, and Alignment Health Plan.

What Does it Cover?

It covers necessary medical services and preventive medical services. These include:

• Outpatient hospital services- Including doctor’s services, emergency room, and surgical services and supplies.
• Preventive services- These consist of screening for various health conditions, for instance, depression, diabetes, cardiovascular disease, cancer, HIV, obesity tests, and other screening services. It also includes flu, Hepatitis B, and pneumococcal vaccinations and counseling for tobacco and alcohol use.
• Medically prescribed Durable Medical Equipment (DME) – For instance walking canes, blood sugar monitors, blood sugar strips, walkers, wheelchairs, crutches, hospital beds, patient lifts, infusion pumps, continuous passive motion devices and other long-lasting medical equipment necessary for your condition.
• Mental health services- This includes inpatient, outpatient, and partial hospital stays.
• Clinical research to ascertain whether certain medical treatments will benefit the patient, or to compare the efficacy of different medical treatments.
• Certain prescription medication
• Ambulance services.

Who is Eligible?

If you qualify for premium-free Medicare Part A, you’re eligible for Part B as well. All you need to do is to enroll and pay the premiums every month.

If you don’t qualify for premium-free Medicare Part A, you need the following to be eligible for part B:

• Be 65 years of age or more and you or your spouse works for a Medicare sponsored employer.
• Be a U.S citizen or,
• Be a permanent resident and have lived in the U.S for at least five consecutive years.

If you are under 65 years of age and you receive Railroad Retirement Board (RRB) or Social Security disability benefits, you automatically get signed up for Part A and B after receiving disability benefits for 24 months.

People with End-stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS), can also enroll for Part B before they hit 65 years.

Part B Premiums

Premiums for Medicare Part B are not constant- they may change yearly. For the year 2020, the standard premium is $144.60 per month. Most people pay this standard amount and have it deducted automatically from their social security benefits every month. Sometimes, however, the amount varies depending on individual situations:

• The premium varies for different levels of income, so your premium could be higher than the standard if your income is above a certain limit.
• People who failed to enroll for Part B when they first became eligible, get slapped with a late-enrollment penalty that raises the amount they have to pay for their premiums.

How Does Medicare Part B Work?

Medicare pays for healthcare through something called assignment. If your healthcare provider accepts assignment, it means that Medicare will pay its share of the fee while you only pay them the Medicare- deductible amount or coinsurance as complete payment for services rendered. The annual deductible Medicare Part B amount for 2020 is $198. In addition to this, you also have to pay 20% coinsurance for the services covered under Part B. So this means that you pay the health care provider the deductible plus 20% of the approved amount for the medical services you receive. In other words, you shouldn’t pay more than the approved amount for the service you got.

Frequently Asked Questions

Can I get medical services from any healthcare provider if I have Part B?

Yes, you can get services from any healthcare provider in the United States as long as they are enrolled in Medicare and accept assignments.

What if I need to change my address?

You can change your address online, or by calling social security, or by going to their offices in person. If you prefer, or you need assistance, contact our offices, and we can assist you.

What if I travel outside of California, to another state or country?

If you have Medicare Part A and/or Part B, you’re covered anywhere in the United States, and in territories governed by the U.S, as long as the healthcare provider is enrolled in Medicare. Outside of the U.S, you have limited or no Medicare cover.

Is there any difference between Medicare Part A and B?

Yes. Part A and B have different costs and cover different things, but requirements for enrollment and eligibility are similar.

Do I have to sign up for both Medicare Part A and B?

No, you don’t. You can sign up for just Part A, but if you later decide to sign up for Part B, you may be required to pay a penalty. In fact, if you have no other health coverage, you’ll pay a penalty of 10% for every year you turned Part B coverage down.

What is coinsurance?

Medicare doesn’t cover the entire cost of some services. For example, for mental services, Medicare covers 80% of the costs. You pay the other 20%. The amount you pay to top-up for the Medicare shortfall is what we call coinsurance.

What if Medicare doesn’t pay for a service I think should be covered?

If you feel that Medicare should have paid for a certain service or that they paid too little, you can file an appeal with them. Contact us, and we will work with you to ensure you get everything squared away.