Medicare is health insurance offered by the U.S. government for seniors 65 years and older and others receiving Social Security disability benefits. Two parts make up Original Medicare: Part A and Part B. Medicare Part A covers your inpatient care, such as your room and board at the hospital, lab services, hospice, and home health care. Medicare Part B is your outpatient medical care. You can find detailed information on Part B’s coverage here: boomerbenefits.com – Medicare Part B. But, keep reading to learn five facts about Medicare Part B!
1. You can be charged a penalty if you delay Part B
The time to apply for Medicare is during your Initial Enrollment Period (IEP). Everyone has a different IEP since it’s based around an individual’s 65th birthday month. The IEP begins three months before your 65th birthday month and ends three months after. You will apply for Medicare through the Social Security office during this time.
You can delay enrolling in Medicare Part B if you or your spouse actively work for a large employer (more than 20 employees) and their group insurance plan covers you. You will be charged a life-long late enrollment penalty if you are not covered by large employer insurance and fail to enroll in Medicare during your IEP.
The Part B penalty is an additional 10% charge for every 12 months you delayed Part B while being eligible. So, if you wait to enroll in Part B for four years without creditable coverage, you will pay 40% more than the Part B premium, forever.
2. Medicare comes with a cost
Hopefully, this doesn’t come as a surprise, but Medicare Part B comes with a cost. Medicare Part B has monthly premiums, an annual deductible, and coinsurance costs. The Social Security office determines your monthly Part B premium by looking at your modified adjusted gross income reported on your tax returns from two years ago. So, if you apply for Medicare in 2022, Social Security will look at your 2020 tax returns.
In 2022, the standard Part B premium is $170.10 per month. But, you will pay a higher Part B premium if you are in a high-income tax bracket. For those who made more than $91,000 individually or more than $182,000 jointly, you will pay an income-related monthly adjustment amount (IRMAA) fee on top of your monthly Part B premium. If you no longer make the same income you did two years ago due to a life-changing event, you can file an IRMAA appeal.
3. Medicare Part B covers outpatient care
Medicare Part B covers the care you receive at an outpatient facility, such as a doctor’s office and emergency room. Here are a few different services that Medicare Part B covers:
- Doctor’s visits
- Ambulance rides
- Durable medical equipment
- Chemotherapy and radiation
- Outpatient surgeries
- Preventative care (i.e., flu shots, mammograms, colonoscopies)
- Lab testing
One thing to keep in mind is that Medicare Part B covers medically necessary services to treat or diagnose an injury, illness, or disease. If you visit the doctor for medical care and your doctor deems and codes your visit and services as medically necessary, then Medicare should cover you. But, there are some services Medicare doesn’t consider to be medically necessary.
4. What does Part B not cover?
Although Medicare Part B covers many outpatient procedures, there are some services that Part B does not cover. For example, Medicare does not cover routine dental, vision, or hearing services. But, this does not mean Medicare wouldn’t cover cataract surgery if you were to develop cataracts, since it would be medically necessary. Medicare will also not cover cosmetic surgeries. So, if you receive Botox or implants, Medicare will deny the services, and you will pay the bill in full.
5. Medicare Part B does not cover all services in full
Medicare Part B covers many preventative services in total but does not cover all services at 100%. For example, when you visit the doctor, you will first be subject to the Part B deductible of $233 in 2022. After you pay the Part B deductible, Medicare will cover 80% of the Medicare-approved costs. You will be responsible for the remaining 20% coinsurance for the rest of the year unless you have a Medicare Supplement that helps cover the Part B coinsurance.
Medicare can look like a maze once you read more into the different Medicare parts and plans. But, you don’t have to be alone on this new journey! Research reputable Medicare brokers and contact one for free Medicare help.
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