What is Medicare Part B?

Medicare Part B is the "medical coverage" portion of Original Medicare that covers preventive services and outpatient services that are considered medically necessary to diagnose or treat an illness. Original Medicare covers only about 80% of your medical expenses. You are responsible to pay the other 20% of your medical costs and 100% of your prescription drug costs. Most Medicare beneficiaries pay a premium for Part B coverage. Services covered under Medicare Part B typically include, but are not limited to, the following:

  • Preventive care
  • Ambulance services
  • Durable Medical Equipment (DME)
  • Clinical research
  • Mental health services – inpatient, outpatient and partial hospitalization
  • X-rays and lab tests
  • Limited outpatient prescription drugs
  • Doctors' services, second opinion
  • Outpatient physical, speech and occupational therapies
  • Chiropractic services (related to subluxation)

A Medicare Advantage plan is another option for covering both inpatient (hospital services) and outpatient (medical services) care. These plans are offered by private health insurance companies and must provide at least the same coverage as Original Medicare.Find out more about your Medicare Advantage options.

 

Who is eligible for Medicare Part B?

To apply for Medicare Part B, there are fewer requirements than Medicare Part A.  You are eligible to sign up for Medicare Part B if you are a U.S. citizen and are 65 years of age or older. You may also be automatically enrolled in Medicare Part B through disability.

While Medicare Part A is available premium-free, Medicare Part B is available with a monthly premium. Most people pay a monthly premium for Medicare Part B of $104.90 and have a deductible of $147 per year. Find out more about Medicare Part B costs.

If you do not apply for Medicare Part B when you are first eligible, you may face a late enrollment penalty when you do enroll. After your Initial Enrollment Period ends, for each 12-month period that you could have had Part B but did not sign up for coverage, your monthly premium for Medicare Part B may increase by 10%. For example: Your Initial Enrollment Period ended on August 31, 2012. You waited to sign up for Part B during the General Enrollment Period in March 2015. Your Part B penalty is 20%, which you will have to pay for as long as you have Part B. (While you waited a total of 31 months, this only accounted for two full 12-month periods.)

Although you may be eligible for Medicare Part A and Medicare Part B, you may prefer additional coverage through a Medicare Supplement Plan, Prescription Drug Plan, or a comprehensive Medicare plan, also known as Medicare Advantage, to manage your medical care costs.

 

When can I apply for Medicare Part B?

There are four enrollment periods during which you may choose Medicare coverage.

Initial Enrollment Period: You can sign up for Medicare during a seven month Initial Enrollment Period (IEP). This period includes the three months before your 65th birthday, the month of your birthday, and the three months after you turn 65.

General Enrollment Period: If you miss your Initial Enrollment Period for Medicare coverage, you may sign up for Medicare between January 1 and March 31 each year during a General Enrollment Period. You could face a late penalty for missing your initial opportunity to enroll in Medicare, but you will be able to apply for coverage during this time.

Annual Election Period: Each year from October 15 to December 7, you may sign up for Medicare coverage or prescription drug coverage to begin January 1 of the following year. Additionally, changes may be made to any existing Medicare plan during this time.

Special Election Period: If you experience a loss of health insurance coverage that was previously covered by your job or union health insurance, you may qualify for a Medicare special enrollment period. This eligibility period will be determined based on the date you lost coverage.

If you fall within one of the four enrollment periods for Medicare coverage, compare Medicare plans with Blue Cross and Blue Shield of Alabama today.

If you miss your Initial Enrollment Period and you do not meet the requirements for premium-free Medicare coverage, you may face an increased premium or late enrollment penalty for Original Medicare coverage.

 

What is not covered by Medicare Part B?

It's a fact: Medicare was never intended to cover all of your medical needs. If you need something that is not covered by Original Medicare, you may pay for the service/equipment yourself or you may want to apply for Medicare plans that include additional coverage. Even with an approved service or item, you will be responsible for paying your deductible, coinsurance and copayments. Medicare Part B does not typically cover:

  • Long-term care (custodial care)
  • Dentures and most dental care
  • Eye exams related to prescription glasses
  • Cosmetic surgery
  • Acupuncture
  • Hearing aids and exams for fitting hearing aids
  • Routine foot care
  • Medical care outside the U.S. (except in a few very limited situations)

You can search Medicare.gov to see if a specific test, item or service is covered.

As a Medicare beneficiary, you probably need more coverage than Original Medicare provides — to help you save money on prescription drugs, doctor copays and other out-of-pocket expenses not covered by Original Medicare. Blue Cross and Blue Shield of Alabama offers a variety of affordable Medicare plans for a variety of needs and budgets. We cover what matters. And we share a common goal — your good health.