Medicare Part B

Medicare Part B: in 2019 & 2020

What it Covers: Outpatient Services

• Doctor visits
• Emergency ambulance services
• Laboratory tests and X-rays
• Durable medical equipment
• Mental health services
• Preventive services, such as flu shots, pap tests, and screenings
• Rehabilitative services, including occupational therapy, speech-language pathology services, and physical therapy

In general, medical procedures that don’t require an overnight stay at a hospital or nursing home or skilled at-home care are covered by Medicare Part B.

Medicare Part B picks up where Part A leaves off, in that it provides essential services and products related to doctor visits and procedures that do not require an overnight stay or other circumstances where you would be considered an inpatient. Inpatient services are covered by Medicare Part A while Medicare Part B covers Outpatient services. Parts A and B work well with each other, come as part of the basic Medicare package and in some situations may not be acquired separately (I.E. you can’t get Part B without getting Part A).

Who is covered by Part B?

Medicare Part B is outpatient medical insurance offered by the federal government to United States citizens and legal immigrants. You’re eligible if you’re 65 and older. Also certain disabilities can qualify you under age 65. Individuals who are eligible for premium-free Medicare Part A are also eligible to enroll in Part B once they are entitled to Medicare Part A.

Medicare Part B provides coverage for outpatient services necessary to treat medical conditions, such as doctor’s visits, lab work, x-rays, outpatient surgeries, preventive services, and medical equipment. Medicare Part A provides coverage for hospital related costs such as hospital stays, nursing care, hospice, and home-health care.

While many people qualify for premium-free Medicare Part A coverage, everyone has to pay insurance premiums for Medicare Part B.

What Does Medicare Part B Cost?

Your monthly premium is based on your income level and when you enroll. You’re eligible to enroll in most cases when you turn 65. The minimum Part B standard monthly premium is $135.50 if any of the following applies to you:

• You began Part B insurance in 2017
• You have not yet received Social Security or Railroad Retirement Board benefits
• You are eligible for both Medicare and Medicaid
• You are directly billed for your Part B premium

Note that if you enroll if you enroll in Medicare Part B late you will have to pay a penalty. Premiums can also be higher depending on your income level. Monthly premiums can go for as high as $460.50 a month. Calculations can be complex, but you can contact the Social Security Administration online at www.SocialSecurity.gov for help.

You can also do so at your local social security office or by calling the national hotline at 1-800-772-1213 (TTY users 1-800-0778) weekdays between 7AM and 7PM eastern time.

Medicare Part B – Coverage and Payments

Medicare Part B provides coverage for outpatient services to treat medical conditions, such as doctor’s visits, lab work, x-rays, outpatient surgeries, preventive services, and medical equipment. For individual services and supplies, your Medicare Part B costs may vary.

The minimum annual deductible for Medicare Part B in 2019 is $185 per year. You have to meet this deductible before you’re eligible for most payments.

Some preventive services are completely covered without requiring you to meet your deductible, if your provider accepts Medicare assignment. These include: most doctor services, outpatient therapy and durable medical equipment (DME). After this deductible is met, you often pay about 20% of the Medicare-approved amount. You may also owe a copayment for certain outpatient services.

Who Signs Up Automatically

If you’re already collecting Social Security or Railroad Retirement Board (RRB) retirement benefits when you turn 65, you will automatically be enrolled in Medicare Part B.¹

If you are disabled and receiving Medicare Part A when you turn 65, will be automatically enrolled in Medicare Part B.

While most people are enrolled in Medicare Part B automatically, you can also manually sign up for coverage. If you don’t receive either Social Security or RRB (possibly because you are still working), then you will have to sign up manually.

You can enroll in Medicare Part B three months before you turn 65 for coverage that starts when you turn 65.

If you are not enrolled automatically, be careful as you should sign up manually for at least 3 months before you turn 65 to avoid possible penalties. Enrollment penalties include an increased 10% of your premium costs for each 12-month period in which you had Plan B but did not sign up for it.

Where to Sign Up Manually

You can do this online at www.SocialSecurity.gov

You can also do so at your local social security office or by calling the national hotline at 1-800-772-1213 (TTY users 1-800-0778) weekdays between 7AM and 7PM eastern time.

Your coverage for Medicare Part A can begin as early as 6 months before the time you filed,

but no earlier than the month in which you have met all Part A requirements.

Eligibility

You must have worked at least 10 years under Medicare Covered Employment by the time you are 65 years old to receive free Medicare Part B.

If you are not eligible for free Medicare Part B, you can purchase it along with Medicare Part A during the general enrollment period or the special enrollment period.

The general enrollment period is every year January 1st to March 31st.

The special enrollment period can occur for a number of different reasons. If you or your spouse continue to work and receive health insurance coverage from an employer, your Special Enrollment Period continues indefinitely. If you lose your job or your health coverage with that job, you have a Special Enrollment Period for 8 months. There are other exceptions, so check with your local Social Security office if you have questions.

More Information

Equipment and Supplies for Medicare

It may be important for some Medicare beneficiaries to have access to senior home care. Finding out how to get this care through private medical insurance is important. Investigate coverage on home medical equipment and senior assisted living. In-home care and home medical equipment are covered under Medicare Part Part B (along with doctor’s visits and other preventive services). There are, however, limitations to this coverage.

Medicare Part B covers medically necessary part-time nursing care.

• It also covers physical therapy, speech/language therapy, and on-going occupational therapy.
• A health care provider (physician or other) that is enrolled in Medicare must order such care, and it must be provided by a Medicare-certified home health agency.
• To get this coverage, you must be homebound, meaning it is extremely difficult for you to leave your home.
• If you are homebound you pay nothing for these services.

Other Medicare Part B-covered services can also include:

• Medical social services
• Part time home health aide services
• Durable medical equipment (DME) and medical supplies

Who can get Medicare-covered home health care and what services does Medicare cover?

If you have Medicare, home health care services are covered if you meet all the following conditions:

• Your doctor must decide that you need medical care at home, and make a plan for you care at home.
• You must need intermittent skilled nursing care, physical therapy, speech-language therapy or to continue occupational therapy.
• The home health agency caring for you must be approved by the Medicare program (Medicare-certified)
• You must be homebound, or normally unable to leave home without help.
• To be homebound means that leaving home takes considerable and taxing effort.
• You can be homebound and still leave home for medical treatment or short, infrequent absences for non-medical reasons, such as trips to a barber or church.
• A need for adult day care doesn’t keep you from getting home health care.

If you meet all four of the conditions above, Medicare will cover the following types of home health care:

• Skilled nursing care on a part-time or intermittent basis

  Skilled nursing care includes services and care that can only be performed safely and correctly by a licensed nurse (either a registered nurse or a licensed practical nurse).

• Home health aide services on a part-time or intermittent basis

  A home health aide doesn’t have a nursing license, but supports the nurse by providing services such as help with bathing, using the bathroom, dressing or other personal care. These types of services don’t need the skills of a licensed nurse. Medicare doesn’t cover home health aide services unless you are also getting skilled care such as nursing care or other therapy. The home health aide services must be part of the home care for you illness or injury.

• Physical therapy, speech-language therapy, and occupational therapy for as long as your doctor says you need it

  1. Physical therapy includes exercises to regain movement and strength in a body area, and training on how to use special equipment or do daily activities, like how to get in and out of a wheelchair or bathtub.
  2. Speech-language therapy (pathology services) includes exercise to regain and strengthen speech skills.
  3. Occupational therapy includes exercise to help you do usual daily activities by yourself. You might learn new ways to eat, put on clothes, comb your hair, and perform other usual daily activities. You may continue to receive occupational therapy if ordered by your doctor even if you no longer need other skilled care.

Medical Social Services

Medicare social services to help you with social and emotional concerns related to your illness.

This might include:

• Counseling or help in finding resources in your community.
• Certain medical supplies, like wound dressings (but not prescription drugs or biologicals).
• Durable medical equipment, such as a wheelchair or walker. It also includes oxygen equipment, hospital beds and other items that are “durable”. That is, you don’t use them once and throw them out.

Medicare does not cover

Medicare does not cover (does not pay for) any of the following:

• 24-hour-a-day care at home
• Meals delivered to your home
• Homemaker services like shopping, cleaning, and laundry
• Personal care given by home health aides like bathing, dressing, and using the bathroom when this is the only care you need.

Arranging for Medicare Home Care

Most of the time, your doctor, a social worker, or a hospital discharge planner will help arrange for Medicare-covered home health care. However, you have a say in which home health care agency you use.

Covering Medical Equipment

Durable medical equipment refers to items like oxygen equipment, wheelchairs, walkers, hospital beds, and other items that are “durable.” You don’t use them once and throw them out. You also use most of these items as part of in-home care. Durable medical equipment must also be ordered by a medical professional enrolled in Medicare. In some cases, equipment must be rented. You have to pay for 20% of Medicare-approved amount (Part B deductible also applies here). Medicare is also beginning a new competitive bidding program that will save money and limit fraud. In some states you will need to get certain equipment from specific suppliers or Medicare will not pay, leaving you with the full bill. This program began January 1, 2011, in several metropolitan areas in California, Florida, Indiana, Kansas, Kentucky, Missouri, North Carolina, Ohio, Pennsylvania, South Carolina and Texas. It is scheduled to include areas in all 50 states by 2016.

Other items are considered durable medical equipment. These include: air fluidized beds, blood glucose monitors, bone growth stimulators, canes, commode chairs, crutches, infusion pumps (and even some medicines used in such pumps), Lymphedema pumps/pneumatic compression devices, scooters, nebulizers (and some medicines used), patient lifts, suction pumps, traction equipment, transcutaneous electronic nerve stimulators, and ventilators. This list is not comprehensive. A number of prosthetic and orthotic items are also considered “durable” and are covered.

You should note that Medicare will not cover motorized scooters and wheelchairs which are primarily used outside the home. Your doctor needs to verify that you need such a scooter for a medical condition. You must have a “certificate of medical necessity” to get any of these items or other durable medical equipment. Medicare usually pays 80% of the costs of such equipment. Note that this is figured on the Medicare-approved amount for these items so the payment might actually be less than 80%. Different durable goods are covered in different ways as well. Some, for instance, may be rented.

Costs

You will pay $0 for all covered home health visits. It should also be noted that if you only have Medicare Part B, then these services will be covered under Part B.

Comparison to Medigap

It is important to also understand that Medigap policies (Medicare Supplement Insurance) no longer cover “At-home Recovery” or “Preventive Care Not Covered by Medicare.” However, Part A Hospice Care is included in all Medicare Supplement Insurance plans.

Depending on your Medigap plan you should be able to get help paying for your share of these items. In some cases, the Medigap plan will fully cover your portion of the bill for durable medical equipment. Contact your insurance company and ask them specifically what is covered. When it comes to durable medical equipment, be sure to find out if your Medigap plan pays for 20% of the Medicare-approved amount, or if it covers any amount over what is covered by Medicare.

If you want to learn more about Medigap plans, please see our Medigap guide.

¹Disclaimer: If you are living in Puerto Rico, you will be automatically enrolled in Medicare Part A (if you are receiving Social Security or RRB benefits), but not Part B. You must manually sign up for Medicare Part B.