Understanding
Medicare Part B

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What is Medicare Part B? 

Medicare Part B is one element of the health insurance program offered by the United States government for people 65 and older or disabled. Parts A and B—often called Original Medicare—are fully managed by the Centers for Medicare and Medicaid Services (CMS), the federal department overseeing Medicare. There are also other parts that are offered by private insurance carriers who are monitored by CMS.  

Who is Eligible for Medicare Part B?

  • Individuals in the US generally become eligible for Medicare Part B when they are turning 65 years old.

  • Younger individuals may be eligible if they are disabled or have ALS or End-Stage Renal Disease (ESRD).

  • If you are older than 65 and don’t have Medicare Part B coverage, you are still eligible to enroll for coverage. 

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What does Medicare Part B Cover? 

Part B covers preventative and medically necessary services and supplies. “Medically necessary” is an important qualifier for Part B. Medicare.gov defines it this way: “services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.” 

Here are some of the services and supplies that may be covered, depending on your situation: 

  • Durable Medical Equipment such as diabetic supplies, hospital bed and mobility equipment like walkers, wheelchairs, canes, etc. 
  • Ambulance transportation, when necessary 
  • Mental health treatment 
  • Mammograms 
  • Flu shot 
  • Yearly check-up 

Many more services are covered by Medicare Part B. This is only a partial list for example. 

Coverage decisions depend on the individual situation and may vary by geographic area. If you have questions about a specific service, you can search the Medicare coverage list or ask your doctor. 

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When to enroll in Medicare Part B

If you are eligible for Medicare due to disability, ALS, or ESRD, your enrollment will be handled through your disability benefits with Social Security, usually at 24 months of receiving benefits.

If you are eligible for Medicare Part B upon turning 65, your first opportunity for enrollment begins with your Initial Enrollment Period. This opportunity begins three months before the month of your 65th birthday and continues for three months after the month of your birthday, a total of 7 months.

If you are already receiving Social Security benefits four months before your birthday, you may be enrolled in Medicare Parts A and B automatically. Even though automatic enrollment is possible, it’s a good idea to check your enrollment.

If you choose to delay receiving your Part B coverage, you may be able to enroll with a Special Enrollment Period if your coverage changes. For example, if you were enrolled in an employer-sponsored health insurance plan, then retire, you will have an opportunity to enroll in Medicare after leaving the employer plan.

You can also enroll in Parts A and B during the General Enrollment Period that runs from January 1 through March 31 each year. If you enroll during that period, your coverage will begin July 1 of that year.

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How to Enroll in Medicare Part B

You can enroll in Medicare Part B through the Social Security Administration. Enrollment can be completed: 

Online 
– By phone: 1-800-772-1213 (TTY: 1-800-325-0778) 
– In person at a local Social Security office 

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Medicare Part B Costs 

Medicare does not pay all of your healthcare costs. Here are a few of the costs you may have with Part B coverage.   

Premium 

Unlike Part A, Part B does usually require a monthly premium. The premium amount can change every year. Some individuals with a higher income pay higher premiums.  

Deductible 

You will have to pay a deductible each year before Part B will start to pay for your healthcare costs.  

Coinsurance 

Once you have paid your deductible, you will pay 20% for each service that Medicare covers.  

Late Fee 

If you delay your Part B coverage for reasons other than employer health coverage, you will probably be subject to a late fee. The fee increases every year that you do not have Part B coverage and you will pay that fee for as long as you have Medicare coverage.  

Help with Part B Costs 

You may be able to reduce your Part B costs with these resources: 

  • Medicare Supplement Plan: helps pay your 20% coinsurance costs, some plans may cover more.
  • Medicaid: if you qualify for Medicaid, it may cover some of your Part B costs.
  • State programs: you may qualify for state programs based on income that will reduce your Medicare costs.
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Last Updated: November 1, 2022 MULTIPLAN_ETQEZMwebsite_0722_M