What is Medicare Part B?

Broadly speaking, Medicare Part B covers outpatient medical services. This part of Medicare encompasses most of the standard healthcare services, such as doctor visits, preventive screenings, and diagnostic testing.

What does Medicare Part B cover?

The services that are covered by Medicare Part B include:

• Preventive care and services
• Office visits
• Doctor services
• Diagnostic testing
• Laboratory tests and screenings
• Outpatient procedures and surgery
• Home health care
• Ambulance services
• Durable medical equipment
• Outpatient care
• Outpatient mental health services
• Mental health partial hospitalization programs
• Prescription drugs administered in an outpatient setting

What’s not covered

Medicare Part B does not cover inpatient care. Inpatient hospital stays and services are covered under Medicare Part A. 

Medicare Part B does not cover outpatient procedures (cosmetic surgery, massage therapy, most dental care, routine foot care, etc.) that are not considered medically necessary. 

Some other items not covered by Medicare include dental, vision, and hearing coverage, with limited exceptions. You could potentially receive some of these additional benefits by enrolling in a Medicare Part C (Medicare Advantage) plan that covers these items instead of Original Medicare.

RELATED: Original Medicare vs. Medicare Advantage

Who is eligible for Medicare Part B? 

Medicare is insurance for people aged 65 or older, or younger people with certain health conditions. If you’re younger than 65, have Lou Gehrig’s disease, End-Stage-Renal Disease (ESRD), or have been on Social Security Disability for 24 months, you may qualify for Medicare.

If you don’t meet the requirements to receive premium-free Medicare Part A, you can enroll in Medicare Part B if the following criteria are met:

• 65 or older 
• A permanent resident who has been living in the U.S. continuously for five years prior to application
• U.S. citizen

A lawfully admitted alien who has come legally for permanent residence must reside in the United States for five continuous years before filing for Medicare.

How much does Medicare Part B cost?

The standard Part B premium amount may be different from one year to the next. For example, between 2020 and 2024, the standard Medicare Part B premium went from $144.60 to $174.70. Monthly premiums may be adjusted based on projected Medicare spending, inflation, and other factors. While some pay the minimum, others with higher incomes may have to pay more.

The Medicare Part B premium can be paid directly or will be automatically deducted for Medicare beneficiaries who are receiving Social Security benefits. They’ll have to pay directly if they aren’t yet receiving Social Security benefits.

Depending on income, an Income Related Monthly Adjusted Amount (IRMAA) may change the monthly premium. In this situation, an additional cost is added to the standard Medicare Part B premium. 

Medicare is billed quarterly for those who are not starting Social Security benefits. However, an individual may elect to have a monthly bill in place of a quarterly bill.  

Medicare Part B doesn’t pay the full cost of services. It has an annual deductible, which varies much like the premiums do. For example, between 2020 and 2024, the deductible went from $198 to $240. After the deductible is met, Medicare will start to pay 80% of an accepting assignment. You’ll be responsible for a 20% coinsurance and any excess charges if your healthcare provider does not accept Medicare assignment.

You can see any doctor nationwide that accepts the Medicare assignment. If you go to a provider that accepts Medicare but not an assignment, you could be subject to up to a 15% excess charge.

Medicare Part B enrollment

Enrollment in Medicare Part B may be automatic and can be completed online, in person, or some cases, over the phone. For the majority of Americans, you should apply during your Initial Enrollment Period.

This begins three months before you turn 65 and continues for three months after the month of your birthday.

If you miss your Initial Enrollment Period, you can enroll during the General Enrollment Period. The GEP begins on Jan. 1 and continues until March 31 annually. Enrolling during the GEP Medicare Part B will begin on the first day of the following month in which you apply.

Sometimes, beneficiaries will delay their Medicare Part B and continue to work. In these cases, they may have a Special Enrollment Period that lasts eight months after their employer coverage ends. Medicare Part B will begin the month after the application for Medicare is received.

If you delayed your Medicare Part B, you’d need to provide forms filled out by your group benefits administrator showing you had creditable coverage. You may be subject to the Medicare Part B late enrollment penalty if you delayed your Part B coverage and did not continue creditable coverage.

It’s important to know that COBRA and Veterans Affairs health coverage isn’t considered creditable for Medicare Part B.

How to save money on Medicare Part B

Medicare coverage is a great starting point, but there may be out-of-pocket expenses, and there is no maximum spending limit. 

Medicare Savings Programs

Medicare Savings Programs (MSP) are a great option to help reduce the costs of Part B. If you qualify for an MSP,  it would help pay for part of your Part A and Part B deductibles, coinsurance, and copayments. MSP qualifications are determined by the state, and in many cases, you must have income and resources below a specified limit to be eligible. 

Medigap

Another option that may reduce Part B costs is Medicare Supplement Insurance Plans (Medigap). Medigap policies are designed to help fill in the “gaps” in Original Medicare and are sold by private companies. These policies may help pay the remaining costs from Original Medicare, like copayments, coinsurance, and deductibles. If a service is required, Medicare will pay its share of the covered healthcare cost, and then the Medigap insurance plan will pay its share. 

Medicare Advantage

A third option is a Medicare Advantage Plan. These plans are sometimes called Part C of Medicare. They combine your Medicare Part A and Part B benefits into one privately-administered plan. These plans are administered by private insurance companies and have their own fee schedules.

Part C plans must cover the same benefits as Original Medicare and have a cap on what an individual can spend during a year.

These plans are popular among Medicare beneficiaries because they typically include prescription drug coverage and additional benefits like dental or vision coverage that aren’t included with Original Medicare.

SingleCare

Prescription drugs you receive from the pharmacy aren’t covered under Medicare Part B. This coverage can be through a Medicare Advantage plan or a Medicare Part D stand-alone prescription drug plan. These plans have different coverage phases and formularies of drugs that they cover.

Medication costs may still be high. If you have a prescription that is not on your plan’s formulary or is very expensive, there are alternative ways to lower the costs.

SingleCare is a free discount prescription program designed to help people with high-cost drugs or no prescription coverage. You can save significant amounts of money on prescriptions. To get your free discount card, simply go to SingleCare, and you can text, download, and email the card to yourself and start saving today.