What is Medicare Part B, and why do you need to enroll? If you just turned 65 years old, you might probably have thought about this question already.
Although Medicare is a federal program, it’s not so new that it can cause confusion to some individuals. Understanding Medicare, its parts, eligibility, and coverage can be complicated at first.
What Is Medicare?
Medicare is a federal health insurance coverage available for people 65 years old and above and young people with qualified disability requirements. It has four different parts, and one of them is Medicare Part B. You must understand how its components work, as eligibility may also vary per part.
Are You Eligible For Part B?
When you turn 65 years old, you’re already eligible to get Medicare Part B coverage. As Part B isn’t premium-free for some, people can decide to opt-out of it if they want to do so. Automatic enrollment may apply only for people who meet these specific criteria:
- If you’re receiving retirement benefits from Social Security or the Railroad Retirement Board
- If you’re eligible for Social Security or the Railroad Retirement Board but haven’t applied yet
- Either you or your spouse has worked for the government and is covered by Medicare
If you don’t qualify in any of the said criteria, you may still voluntarily sign up for Medicare Part B.
Other Condition To Qualify
People below 65 years old may also be eligible for Part B if
- They’ve been eligible for Social Security or Railroad Retirement Board disability payments for the past four months or
- They’re on dialysis or have had a kidney transplant.
Not enrolling to Medicare Part B when you’re first eligible might incur late enrollment penalties.
If you’re planning to get Medicare Part B coverage, understanding premiums and their coverage is essential. Most beneficiaries of Part B don’t understand how their policy works. That’s why they get surprised every time they receive bills for their medical expenses.
It would be best if you keep in mind that, unlike Part A, Medicare Part B isn’t premium free. You need to pay a monthly premium to keep your plan active. On top of your premium, remember that you also need to satisfy your deductible first. A deductible is a specific target amount that you need to pay for medical expenses covered by Medicare out of your pocket before your Part B coverage kicks in.
Once you meet your deductible, co-sharing will then apply. Co-sharing means Part B will pay a specific percentage of the total allowed amount, then you’ll pay for the remaining. The allowed amount is the standard rate priced by Medicare for certain services. For example, your sick office visit’s total cost is $100, Medicare’s allowed amount is $80.00, and the co-sharing amount is 80/20. Medicare pays 80% of the $80.00, and the remaining $20% is your responsibility.
Outpatient Services Covered
Outpatient services are medical treatments or examinations performed in a medical facility without requiring an overnight stay, known as outpatient. In a few hours, several procedures and tests can be completed in these facilities. The following are some examples of outpatient services that are covered under Medicare Part B:
- Sick Office Visits
Like any other insurance, Medicare Part B covers sick office consultation or doctor’s visits. The cost of the visit can be covered by your premium, copay, or coinsurance.
- Durable Medical Equipment
Equipment, devices, and supplies are also part of its coverage, though, some equipment might not be covered, depending on its medical necessity.
- Outpatient Laboratory Services
These can include x-ray, blood tests, and other laboratory tests.
- Emergency Services
These include services that need to be performed for life-threatening situations. Coverage might include emergency room charges and surgical procedures, among others.
- Urgent Care Services
These are services that are non-life-threatening, but immediate care is needed.
Preventive Care Coverage
Preventive services cover preventive medicine aids in the detection and prevention of chronic diseases and medical issues before they become serious. Preventive treatment includes annual checkups. Some examinations and screenings are also part of Part B coverage.
Although Medicare Part B covers most outpatient services, including screenings, certain services may also be excluded. That’s why even if you have Medicare, it’s still a must to prepare for unexpected medical expenses. It’s to avoid bankruptcy if an unexpected non-covered expensive medical service is needed.
Below are some excluded services under Medicare Part B:
- Routine Foot Care
Toenail clipping and removing corns and calluses are examples of routine foot care. Except under rare circumstances, Medicare doesn’t cover these.
- Cosmetic Surgery
Cosmetic surgery is usually not covered by Medicare unless required due to an accident or to enhance the function of a malformed body part.
- Long-term Care
Also known as custodial care, it’s a series of services and facilities designed to assist you with your care needs. Long-term care is primarily non-medical in nature. Instead, most long-term care services consist of assistance with basic personal activities, including bathing, dressing, and using the restroom.
Medicare Part B isn’t premium free, and not everyone can be automatically enrolled once they turn 65. However, there are specific disability conditions that might qualify a person for Medicare coverage. Certain medical expenses may also be excluded, which one needs to keep in mind.
Lastly, not enrolling when you first became eligible might result in late enrollment fees. That’s why it’s better to enroll immediately upon becoming entitled than being penalized.