Medicare Part B

Medicare Part B is a federal insurance plan that provides coverage for “medically necessary” healthcare. It’s an essential health plan for the retired and disabled.

Original Medicare and Part B Coverage

Medicare Part B is a part of Original Medicare with Part A. You need to have both A and B before you are eligible for additional Medicare plans, though technically neither is required by law (as long as you have some health insurance).

To be eligible for Medicare Part B, you must be at least 65 years old, have a disability and have earned at least 24 months of Social Security Disability Insurance (SSDI), or have End-Stage Renal Disease (ESRD) or Lou Gehrig’s Disease (ALS).

Generally speaking, Medicare Part B covers two categories of benefits:

Medically necessary services: Services or supplies needed to diagnose or treat your medical condition. The doctor, location, etc. must also be Medicare-approved.
Preventive services: Health care to prevent illness (like a flu shot) or detect it at an early stage (like a screening).

If your Medicare-approved physician determines that it’s necessary for your treatment or care, it will at least be partially covered. Here are a few common benefits:

Clinical research
Ambulance services
Durable medical equipment (DME)
Mental health services
Outpatient care
Partial hospitalization
Limited outpatient prescription drugs

Part B Enrollment

Medicare Part B enrollment is simple. First, you need to know when you become eligible. You can enroll starting 3 months before your 65th birthday. You’ll have until 3 months after your 65th birthday — this 7-month window is called the Initial Enrollment Period (IEP).

If you miss your IEP, you can also enroll in Part B during the General Enrollment Period (GEP) that takes place from January 1st through March 31st.

However, if you enroll during the GEP, you may be faced with a late enrollment penalty for Part B, as well as Part D if you choose to enroll in it as well. Your monthly premium may go up 10% every year you could’ve had Part B but didn’t sign up.

Part B Costs

The costs for Part B are standard for every eligible member. This includes its premium and deductible, as well as standard out-of-pocket copayment/coinsurance fees.

The Part B premium for 2022 is $170.10. This price point will likely continue to increase each year, so it’s important to check back and plan accordingly each year.

The same increase happens to the Part B deductible as well. In 2022, the Part B deductible is $233.

You will typically have a copayment or coinsurance fee for your Part B coverage. If you’re required to pay it, it’s typically 20% of the total cost.

Understand Every Part of Medicare

Priority Health Insurance Services is your Medicare partner for every step from enrollment and beyond. To learn more, call 626-966-1098, or email info@priorityhealthins.com.