Medicare Part B
Part B Is Your Outpatient Medical Coverage
Medicare Part B is health insurance that covers outpatient services that are considered medically necessary or preventative. By “medically necessary” we mean that the services or supplies are needed to diagnose or treat your medical condition. Preventative services are performed to detect or prevent illnesses. Keep reading to learn more about Part B!
What Does Part B Cover?
Part B includes benefits like:
- Ambulance services
- Inpatient and outpatient care
- Clinical research
- Durable Medicare Equipment (DME)
Medicare Part B Medical Coverage
What's Covered for Inpatient Stays?
- Doctor visits
- Outpatient care
- Home health care
- Preventative care
- Durable equipment
- Ambulance rides
- Certain medications
You can visit http://www.medicare.gov/coverage and search whether a service is covered by Medicare.
Is There a Deductible?
Yes, Part B has a deductible of $203 in 2021 — which you owe before you can get benefits. You’ll pay this amount directly to the provider, not Medicare. Medicare will tally these paid medical expenses as reported by your doctor and will know when you meet your deductible.
After you meet your deductible, you’ll pay 20% for most healthcare services. If you need major medical services, it can get quite expensive as there’s no “cap” on what you could pay out of pocket.
Get the right coverage at the right price.
Excess Charges
In rare cases, you may also be required to pay an extra 15% in excess charges if your state allows them, and a physician decides to charge the extra fee. You can check with your physician’s billing department to see if they charge the additional 15% charge.
What Does Part B Cost?
This can get somewhat confusing because there are many factors that determine what your Part B premium is — including when your start date is and your income level.
In 2021, the standard premium for Part B is $148.50 per month. However, not all recipients pay this amount. There are multiple categories of recipients paying different premiums. Examine the chart below:
If your yearly income in 2019 (what you pay in 2021) was
File individual tax return
File joint tax return
File married & separate tax return
You pay each month (in 2021)
$88,000 or less
$176,000 or less
$88,000 or less
$148.50
above $88,000
up to $111,000
above $176,000
up to $222,000
Not applicable
$207.90
above $111,000
up to $138,000
above $222,000
up to $276,000
Not applicable
$297.00
above $138,000
up to $165,000
above $276,000
up to $330,000
Not applicable
$386.10
above $165,000 and
less than $500,000
above $330,000 and
less than $750,000
above $88,000 and
less than $412,000
$475.20
$500,000 or above
$750,000 or above
$412,000 or above
$504.90
Do You Need to Sign Up?
If you aren’t receiving beneits from Social Security or the Railroad Retirement Board (RRB) at least four months before turning 65, you’ll have to sign up with Social Security to get Part B.
For those who need to sign up, you can apply online, visit your local Social Security office, or call 1-800-772-1213 (TTY: 1-800-325-0778).
If you worked for a railroad, call 1-877-772-5772 to reach the RRB.
Medicare Part B Penalty
Most of the time, if you don’t enroll in Part B when you’re first eligible, you’ll need to pay a late enrollment penalty. You’ll have to pay this fee for as long as you have Part B coverage. Your monthly premium might go up 10% for each ful 12-month period that you were eligible for Part B but didn’t enroll.
You may also have to wait until the General Enrollment Period (January 1 to March 31) to sign up for Part B, and coverage will begin July 1 of that year.
The exception: If you meet certain conditions that let you sign up for Part B during a Special Enrollment Period, you typically don’t pay a late penalty.
The bottom line is, enroll in Part B during your Initial Enrollment Period to avoid a costly penalty.
Have Questions? Call Oak Haven Insurance Agency
Knowing when to enroll in the different parts of Medicare can be confusing. If you have questions, please give Oak Haven Insurance a call! Our experts are here to help.
