With Medicare Part B, you have medical insurance which pays for medical supplies, if they are medically necessary, and services to manage your health. Some services covered include durable medical equipment, outpatient care, ambulance services, and preventive services. For preventive services, Medicare Part B coverage includes hepatitis B and flu shots, cancer and diabetes screening. If your doctor orders it, you could also receive physical therapy and other rehabilitative services.
With the Medicare Advantage plan, private health insurers, contracted with Medicare can provide you both Part A and Part B. Some Advantage plans offer hearing, vision or dental coverage, which original Medicare does not. However, all Medicare Advantage plans are legally required to provide coverage at least to the same degree as original Medicare.
Who has Eligibility for Part B?
If you qualify to receive premium-free Medicare Part A, then you are also eligible to enroll for free in Medicare Part B. Although when you join in Part B, Medicare requires you to pay a premium on a monthly basis. For those who do not meet the eligibility requirements for premium-free Medicare Part A, you may still qualify for Part B under these conditions:
- You are 65 years old or older
- You are a U.S. citizen or a permanent legal resident who has lived in the U.S. for at least five consecutive years.
Qualification for Part B insurance could be automatic if you are receiving disability benefits. If you are not yet 65 but receive Railroad Retirement Board (RRB) or Social Security payments, after 24 months of receiving such benefits, you will automatically get enrolled in Part A and B. You may also qualify for Part B before the age of 65 if you have either ALS (amyotrophic lateral sclerosis) or ESRD (end-stage renal disease).
When Should You Enroll in Part B?
There is an initial registration period, but if you don‘t enroll during that time, and you are not eligible for a special registration period, you can sign up when it’s time for the general enrollment period (GEP). The GEP runs from January 1 to March 31. If you enroll then, your coverage will begin on July 1. When you did not sign up when you were first eligible to do so, Medicare might require you to pay a late registration fee as a penalty.
If you do not meet the criteria for automatic enrollment, you can apply to receive Medicare with the Social Security Administration at an office, on their official website, or by dialing 1-800-772-1213 (TTY 1-800-325-0778) from 7 am to 7 pm, Monday through Friday.
As soon as you have Medicare Part B and also 65 years or older, Medigap open registration begins and lasts for six months. During this time, it is best to buy a Medicare supplement insurance plan because only during open registration do you get “guaranteed-issue” rights. With this admittance, you can purchase any Medigap plan minus medical underwriting or a need to pay higher premiums because of any pre-existing conditions.
What if You Delay Your Part B Enrollment?
Most people pay a monthly premium for Part B insurance even though they get Part A without one. If an employer or group plan covers your medical expenses, whether it is your spouse’s employer or your own, some people may hold off after their initial period ends to enroll. There is a special registration period if you delay signing up for Part B, and you don‘t have to pay a late penalty. The period lasts for eight months following the end of your employer coverage. However, you enroll in Medicare Part B any time while you still have coverage.
If you have COBRA or retiree coverage, it is not contingent on any current employment, which disqualifies you for the special registration. Whether or not you have COBRA following the termination of your current group or employer coverage, the special registration begins as soon as your employer insurance ends.
Medicare Part B Coverage Breakdown
With Medicare Part B, you have help with paying for preventive services like screenings and checkups and other services medically needed to treat a condition. There are restrictions and limits sometimes with what services Medicare covers. It could include stipulations such as how often you receive assistance and how much of a supply you can get. If this is the case, you can apply your deductible. Depending on what kind of Advantage plan or supplement insurance coverage you have, a provider could ask you to make a copayment.
Some services and supplies covered under Part B include these:
- Immunosuppressive drugs and transplants
- Ambulance services
- Cardiac rehabilitation
- Speech therapy
- Chiropractic services
- Smoking cessation
- Training for diabetes self-management
- Diabetes supplies
- Second opinions about surgery
- Durable medical equipment
- Tests and scans
- Outpatient surgical and medical supplies and services
- ER services
- Low-cost or free clinics
- Pulmonary rehabilitation
- Orthotic and prosthetic items
- Balance and hearing exams
- Prescription drugs
- Kidney dialysis supplies and services
- Physical therapy
- Outpatient mental health care
- Physical exams
- Occupational therapy