Understanding how Medicare works can help you get the most out of your coverage, and make informed decisions on your insurance. Original Medicare divides your health coverage by Medicare Part A and Medicare Part B. Medicare A represents your inpatient health services, Medicare Part B, your outpatient treatment.
What are the Medicare Part B Eligibility Guidelines?
In order to have Medicare Part B, you must be eligible for Medicare Part A. In a nutshell, you need to meet the following requirements:
- You’re a U.S. citizen, or a lawful resident who’s lived in the U.S. for at least five consecutive year
- You’re at least 65 years or older, or you’ve been receiving disability benefits for at least 24 months (less if you have End-Stage Renal Disease or Amyotrophic Lateral Sclerosis)
If you’re drawing Social Security before you’re eligible for Medicare, you’ll be automatically enrolled in Part B. You can verify that you’ve been enrolled by checking the “Part B Start Date” on your Medicare card, which you’ll receive in the mail three months before your 65th birthday (or on the 25th month of disability).
What Does Medicare Part B Cover?
Medicare Part B covers your outpatient treatment. These services must be medically necessary, such as cataract surgery or performed in order to prevent or detect illness, like a routine colonoscopy.
Part B benefits include:
- Ambulance services
- Routine wellness visits
- Outpatient doctor appointments
- Some vaccines
- Participating urgent care facilities
- DME (durable medical equipment)
For your services to be covered, you must receive them from a provider that accepts Medicare. Fortunately, most providers are on the nationwide Medicare network. You also need to ensure that you’re receiving your treatment following Medicare’s guidelines, or you could be responsible for the bill yourself. As an example, if you’d like to have Medicare pay for your DME, you must first get a prescription from your doctor, and then purchase it from an authorized supplier.
What Does Medicare Part B Cost?
The Medicare Part B premium is based on your income. For most people in 2020, the premium is $144.60 per month. If you’re in a low-income situation, you may qualify for a free Part B premium with the help of a Medicare Savings Program.
Part B also has some out-of-pocket costs. Unless you have another form of insurance, you’ll be responsible for the following:
- 20% coinsurance on most services, items, and treatments (no maximum out-of-pocket limit)
- Excess charges of up to an additional 15%, if your provider doesn’t accept Medicare assignment (the amount that Medicare agrees to pay)
- The Medicare Part B annual deductible of $198 in 2020
Medicare Part B provides great coverage, but the out-of-pocket costs can add up quickly. Fortunately, you have options. Medicare Supplement insurance can eliminate or reduce the costs left over by Medicare, so that you can get the treatment you need without worrying about the bill. GoMedigap does not offer Medicare plans. To apply for Medicare Part
Nothing on this website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.