Medicare Part B — Medical Insurance


Overview of Medicare Part B

Medicare Part B helps pay for doctors' services, outpatient hospital care, durable medical equipment and some other medical services. While Medicare Part B is optional, it is usually required before you can purchase additional coverage such as prescription drug coverage. There is a monthly premium that most people choose to have deducted directly from their monthly Social Security checks. If you use Medicare Part B services, you have to pay an annual deductible and coinsurance for some services.

Medicare Part B Eligible Services

  • Doctor services, including office appointments; hospital, clinic and home visits; and surgery.
  • Diagnostic X-rays, laboratory tests, radiation therapy and other procedures that are part of your treatment but are not covered under Medicare Part A.
  • Medical supplies and services, including surgical dressings, splints, casts and other devices; oxygen, ventilator-assist devices and durable medical equipment used in your home; prosthetic devices; and portable X-ray services.
  • Outpatient diagnostic or treatment services provided by certified hospitals, skilled nursing facilities, home health care facilities or rehabilitation facilities and ambulance transportation.
  • Ambulatory surgical center services, including coverage for services provided in connection with certain procedures performed at a Medicare-certified ambulatory surgical center.
  • Comprehensive outpatient rehabilitation services delivered at an outpatient rehabilitation facility, doctor's office, skilled nursing facility, hospital emergency room or home.
  • Visits for home health care when ordered by a doctor and provided by a nurse and/or therapist from a Medicare-certified home health agency.
Service In 2013 You Pay In 2013 Medicare Pays
Medical expenses
Physician services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment You pay a $147 annual deductible, then 20% of Medicare-approved charges Medicare pays 80%
Clinical laboratory services
Blood tests for diagnostic services You pay nothing Medicare covers 100%
Other benefits under Medicare
Benefits for medically necessary emergency care received in a foreign country (except in some parts of Canada and Mexico) You pay 100% of expenses Medicare pays nothing
Preventive services You pay for some services Medicare pays for some services. See preventive services chart
Outpatient prescription drugs Costs will vary based on the Part D plan and benefit level you select Medicare's portion varies

Many preventive services are covered by Medicare B*:

Preventive Care & Screenings Purpose Frequency
Flu vaccine Protects against influenza virus Annually during flu season
Pneumonia vaccine Protects against pneumococcal pneumonia Needed only once
Cardiovascular health Checks cholesterol, lipids and triglycerides to determine level of heart disease risk Once every 5 years
Colorectal cancer Screens for colon cancer Ask your doctor
Welcome to Medicare Physical Exam One-time review of health history Once during first 6 months of Part B enrollment
Diabetes Test blood sugar Ask your doctor
Mammogram Screens for breast cancer Annually for women over 40
Pap test and Pelvic exam Screens for cervical and vaginal cancers Once every 24 months, or every 12 months for women at high risk
Prostate Specific Antigen (PSA) an digital rectal exam Screens for prostate cancer Once every 12 months for men over 50

*This list is not comprehensive

Medicare Part B Eligibility

  • You are eligible for Medicare Part B coverage if you or your spouse paid into Social Security for at least 10 years while employed and you are a citizen or permanent resident of the United States.
  • With Medicare Part B, there is a monthly premium, a deductible and coinsurance.

Medicare Part B Enrollment

There are three opportunities to sign up for Medicare Part B:

Initial Enrollment Period for Medicare Part B

  • During the Medicare Part B initial enrollment period, you can enroll three months prior to, during the month of or three months after your 65th birthday; or after your 24th month of receiving cash disability benefits.
  • If you want to decline Medicare Part B enrollment during the initial enrollment period, you must return your Medicare Part B notice to Social Security.
  • If you do not sign up, a 10 percent penalty may be added to the Medicare Part B premium for each 12-month period you could have had Medicare Part B but didn't sign up for it. The penalty continues for as long as you have Medicare Part B.

Special Enrollment Period for Medicare Part B

  • If you or your spouse has medical coverage through a union or an employer with more than 20 employees or you had Medicare Part B coverage and dropped it because you went back to work and had group medical coverage, you can use the Part B special enrollment period to enroll.
  • The special enrollment period lasts for eight months and begins when your employer or union coverage ends, or when employment ends; whichever is first.
  • To use the Part B special enrollment period, contact Social Security four months before you retire or when your employer or union coverage ends and request a form that your employer will need to complete in order to activate your special enrollment. Attach the completed employer form to your Medicare Part B enrollment form and send them to Social Security.

General Enrollment Period for Medicare Part B

  • If you do not enroll in Medicare Part B during the initial or special enrollment periods, you can enroll during the general enrollment period from January 1 through March 31 of each year, with coverage not starting until July 1.
  • For each year you are late in enrolling, you may be charged a 10 percent Medicare Part B penalty.
  • The amount charged increases annually as Medicare premiums increase and will continue for your lifetime or as long you are on Medicare Part B. (Note: if you continue to work after age 65 and are enrolled in a group health plan through your employer, you may decide to delay enrolling in Part B until you retire.)