Medicare Part B

Medicare Part B Covers these services:

Part B of Medicare provides coverage for outpatient and medical services. Below is a list of services that are covered under Medicare Part B coverage

• Provider Services: These are services that you received from a healthcare professional. These types of services can be received from a doctor, nurse or any other qualified medical professional.
• Durable Medical Equipment (DME): DME are things like wheelchairs, crutches, oxygen tanks and other medical devices that can be used repeatedly. They can be either bought or rented from a Medicare approved supplier once they have been deemed medically necessary.
• Home Health Services: These are services that provide skilled nursing or therapy care if you are “homebound”
• Ambulance Services: This is coverage for emergency transport to the hospital. It usually will not include non emergency transportation except in rare occasions.
• Preventative Services: These include things like annual check up, health screenings, and preventative care.
• Therapy Services: These include outpatient physical therapy, speech and occupational therapies offered by Medicare approved therapists.
• Mental Health Services
• X-rays
• Lab tests
• Specific prescription drugs: These are drugs that are typically administered by a doctor and include – Immunosuppressant drugs, anti-cancer drugs, dialysis drugs and other injectable drugs.

This is not a complete list of services covered by Medicare Part B, it is just a few. Additionally Medicare Part B will not cover 100% of the cost of most of these services there will be copays and deductibles that may apply.

 Medicare Part B

       There are two parts that make up Original Medicare. They are Medicare Part A and Medicare Part B. Both portions are administered by the federal government to provide health coverage to Medicare recipients.

In general Part B will cover medically necessary outpatient services, supplies, preventative care, and Durable Medical Equipment.

Services Covered by Medicare Part B:

Below are a list of services that are covered by Medicare Part B

•  Ambulance services
• Chemotherapy
•  Diagnostic tests and lab work
•  Doctors services, like doctors visits
•  Durable medical equipment (DME)
• Home health services
•  Outpatient physical, speech, and occupational therapy services provided by a Medicare-certified physical, speech, or occupational therapist
• Outpatient mental health services
•  Preventive-care services, including screenings and vaccines
• Yearly “Wellness” physical exams
•  X-rays

For people who are enrolled in a Medicare Advantage plan (Part C) they are still enrolled in Medicare Part A and Part B. Medicare Advantage plans are required to provide the same benefits as original Medicare but are managed by a private health insurance company rather than the federal government. Additionally in a Medicare Advantage plan it is possible to gain additional benefits like Dental, Vision, Gym memberships, prescription drug coverage and transportation benefits.

Who is eligible for Medicare Part B Coverage?

To be eligible for Medicare Part B you must be a US citizen or be a permanent legal resident for at least five continuous years. In general, you must be 65 years or older unless you have specific health conditions like ALS or Lou Gehrig’s disease or End Stage Renal Disease (ESRD). There is usually a monthly cost for Medicare Part B even if the recipient has worked in the USA for 10 years or 40 quarters and paid into the Medicare tax. The cost will vary based on a person’s income, higher income earners will pay more than lower income earners.

How to get Medicare Part B?

For people who are receiving retirement benefits from Social Security or RailRoad Retirement benefits before the age 65; on the month of their 65 birthday they will be automatically enrolled into Medicare Part A and Part B. Three months prior they should also receive a welcome packet from Medicare which includes their red, white, and blue Medicare Beneficiary Card.  

Alternatively, if you are not receiving retirement benefits prior to turning 65 you may not be automatically enrolled into Medicare and could be required to apply through Medicare for Medicare benefits. You are able to do this during a seven-month initial enrollment period (IEP) which starts three months before your 65 birthday and ends three months after your birthday month. For those individuals who miss their initial enrollment period, they will be able to enroll again during the General Enrollment Period (GEP) which happens every year from January 1st through March 31st. But it is important to know that if somebody enrolls late into Medicare they may have to pay a penalty for not enrolling when they were initially eligible. Additionally if you enroll in Medicare Part B during the GEP your Medicare coverage will start as of July 1st of that year.

If a Medicare beneficiary is still working after the age of 65 they may be able to delay enrolling into Medicare and also avoid any penalties if the coverage offered through work is equally good or better than what is offered by Medicare. Once a person leaves their work coverage they will qualify for an eight Month Special Enrollment Period (SEP) that will start once the work coverage ends.

Medicare Part B Costs:

For a majority of people enrolled into Medicare, based on work history they will not have a cost for Medicare Part A but they will have a monthly premium for Medicare part B. The premium can change every year but is based on a Beneficiaries income. For recipients with income that is low they may not have to pay any monthly premium if they qualify for low income programs like Medicaid or Medi-cal. For Individuals who have higher incomes they may have to pay more monthly.

For outpatient services that are received under Medicare Part B, there are additional costs each time a service is used. There are copays , coinsurance and deductibles. In general, once the Medicare Part B deductible is met, then Medicare will pay 20% of a person’s outpatient healthcare costs. However there is no limit to how much a person can spend through the year.

If you still have questions about your Medicare options or how you can get enrolled, please feel free to contact through our website at www.EnrollSocal.com or by phone at 844-367-6555. We are able to assist you review your Medicare options for free. You may have a variety of options via Medicare Supplement plans, Medicare Advantage plans or Stand Alone Medicare Prescription Drug plans, that can help you bring down your cost and provide additional benefits that are not covered by Original Medicare only.

We are the Covered California Enrollment Center, your place to get free assistance with your health insurance plan. We can assist you to sign up, enroll and update your private health Insurance, Covered California plan, Medi-Cal, Obamacare and Medicare insurances. Our California agency is certified by Covered California, to assist you in-person, over the phone or online in English and Spanish. 

We specialize in individual and family health insurance plans, Medicare, Medicare Advantage plans, Medicare Supplement (MediGap plans), Medicare Prescription Drug plans (Part D), as well as, Dental and Vision coverage. We can help you get enrolled into health insurance plans, compare healthcare options, provide required health coverage tax documents and review the plans that best fit your budget and healthcare needs.  

Call us today at 844-367-6555 for free assistance over the phone, visit our website at www.EnrollSocal.Com to make an appointment at our California Enrollment Centers Serving San Diego County, Los Angeles County and Imperial County. 

This website and its contents are for informational purposes only. Nothing on the 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.