What is Medicare Part B?

Original Medicare, provided by the federal government, has two parts: Part A and Part B. Medicare Part B covers doctor visits, preventative care, many emergency medical services and other outpatient costs like physical therapy. Medicare Part A helps pay for inpatient hospital stays, skilled nursing care, hospice care and some home-health services.


Medicare Part B coverage is optional.


What Does Medicare Part B Cover?

Medicare Part B covers the care you receive as an outpatient in a clinic or hospital. It also covers the doctor services you receive during an inpatient hospital stay.


Specific Medicare Part B coverage includes:

  • Routine doctor visits or annual wellness checks
  • Ambulatory surgery center services
  • Preventative care (e.g., flu shots, screening mammograms)
  • Outpatient mental health services
  • Clinical lab tests (e.g. blood and urine tests)
  • Diagnostic tests (e.g., MRI, X-rays, CT scans)
  • Durable medical equipment
  • Emergency Room services
  • Part-time skilled nursing care or health aide services

Medicare Part B does not provide comprehensive prescription drug coverage.


How Much Does Medicare Part B Cost?

While Medicare Part A is free for most Americans, Medicare Part B has a monthly premium. If you’re receiving Social Security benefits, your Medicare Part B premium is automatically deducted from your monthly Social Security check. If you’re not receiving Social Security benefits, you will need to send a monthly premium payment to Medicare.


Medicare Part B premiums are based on your household income. Some individuals with higher incomes pay more, while low income individuals may qualify for reduced premiums. Keep in mind that if you’re married, Part B premiums are individual, not combined. Premiums are set each year by the Centers for Medicare and Medicaid Services (CMS), so your premium may change from year to year.


Medicare Part B has an annual deductible as well. Once you have met this deductible, you’ll typically be responsible for a Medicare coinsurance payment of 20% of the Medicare-approved amount for any covered health service.


Here is an outline of the different costs that may apply (costs shown are for 2020).


Premium:

Per month: $144.60 to $491.60 depending on income


Your monthly premium may be less than $144.60 if you enrolled in Part B in 2018 or earlier and your payments are deducted from your monthly Social Security checks.


Your monthly premium could be more than $144.60 if your reported adjusted gross income from 2018 was more than $87,000 for individuals or $174,000 for couples.


Deductible:

Per year: $198


Co-insurance:

Most medical services: 20% of the Medicare-approved amount
Durable medical equipment: 20% of the Medicare-approved amount
Outpatient mental health care: 20% of the Medicare-approved amount


Part B may charge a premium penalty if you do not sign up when you are first eligible, unless you qualify for a Special Enrollment Period.


When and How Can I Sign Up for Medicare Part B?

Like Medicare Part A, you’re automatically enrolled in Medicare Part B if you receive Social Security retirement benefits. If you do not receive retirement benefits, you must enroll in Medicare Part B by filing a request with Social Security during your Initial Enrollment Period (IEP) or the General Enrollment Period (GEP).


If you are still working and covered by an employer healthcare plan or are covered by a spouse’s employer healthcare plan, you may choose not to sign up for Medicare Part B. To delay Medicare Part B enrollment, contact Social Security. You will be able to enroll in Medicare Part B at a later date without paying a late penalty.


It’s important to understand all your Medicare options. HelloMedicare can help. Learn more about the Medicare coverage available in your area with our personalized Guided Path tool.