Medicare Part B: Your Comprehensive Guide 2023
Understand Part B eligibility, enrollment, coverage, costs, and more.
What Is Medicare Part B?
For Medicare recipients, Part B is known as your medical insurance.
It’s one of two parts that make up Original Medicare, which is the basic coverage provided through enrollment.
Part B helps to cover costs for a wide range of medical services that extend beyond inpatient treatment.
In this way, Part B is seen as picking up the coverage when Part A’s hospital care ends.
While it is a part of Original Medicare, some people choose to defer Part B enrollment.
This decision is often influenced by personal factors like your current insurance coverage, employment status, and more.
Those factors and the decision about whether to defer Part B coverage will be covered below.
In this guide, we’ll help you develop a solid understanding of Medicare Part B and how it applies to your healthcare needs.
If you’re looking for a particular topic related to Part B, feel free to jump ahead. Here are the topics we’ll cover throughout.
Guide to Medicare Part B Topics:
What is Medicare Part B?
Am I Eligible for Medicare Part B?
How Do I Enroll in Part B?
What Does Medicare Part B Cover?
How Much Does Medicare Part B Cost?
How to Pay Your Part B Premium
Am I Eligible for Medicare Part B?
If you’re eligible for Medicare Part A, then you’re also eligible to enroll in Part B coverage.
So, just like with Part A eligibility, if you’re the age of 65 or older, a U.S. Citizen or Permanent Legal Resident of at least 5 consecutive years, then you’re eligible for Medicare Part B.
Some are eligible for Medicare before they turn 65. If you’re already receiving retirement or disability benefits, you’re likely eligible for Medicare Part B.
In this case, Medicare will deduct the cost of your Part B monthly premium from your Social Security check.
The same is true if you have End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (Lou Gehrig’s Disease, ALS).
How Do I Enroll in Medicare Part B?
If you’re already receiving Social Security benefits then you will be automatically enrolled in Medicare Part B (along with Part A).
If this applies to you, then roughly 3 months prior to your 65th birthday, you will receive your Medicare card in the mail.
Following this, your coverage will begin on the first day of your 65th birthday month.
Note: If your birthday falls on the 1st of the month then your Part A benefits will begin the month before your 65th birthday month.
If you’re already receiving Social Security benefits but do not wish to enroll in Part B, you can notify Social Security of this decision and return your card.
There are instructions for this on the back of your card. It’s important to notify them so that a monthly Part B premium is not deducted from your Social Security check.
If you’re not receiving Social Security benefits you’ll need to sign up for Part B through Social Security. There are three options for signing up:
Sign up online at the Social Security website. (Link)
Phone call: 1-800-772-1213 TTY: 1-800-325-0778
Local Office Visit: Find your local office using the Social Security Office Locator. It is best to first call and make an appointment before visiting.
If you’re enrolling in Part B, the best time to do so is during your Initial Enrollment Period.
Your Initial Enrollment Period is a seven month long period that begins 3 months prior to your 65th birthday month, includes your birthday month, then extends 3 more additional months.
Note: If you have become eligible for Medicare because of a disability or permanent kidney failure, your Initial Enrollment Period is based on the date your disability began or the date you started treatment.
If you missed enrolling for Part B during your Initial Enrollment Period, you’re locked out of Part B coverage until your next available enrollment period.
Your next chance to enroll in Part B is during General Enrollment.
The General Enrollment Period runs from January 1 to March 31. If you enroll during this period, your coverage will begin on July 1 of that year.
When Does My Part B Coverage Begin?
The start date of your coverage will depend on when you enrolled during your Initial Enrollment Period.
This is a seven month period that begins 3 months prior to your 65th birthday month, includes your birthday month, then extends 3 more additional months.
If you sign up in the 3 months leading up to your birthday, your coverage will start the 1st of your birthday month. (Unless if your birthday is on the 1st of the month, then it starts a month early).
If you sign up the month of your 65th birthday, your coverage will start in 1 month.
If you sign up 1 month after your birthday month, your coverage will start in 2 months.
If you sign up 2 to 3 months after your birthday month, your coverage will start in 3 months.
Note: Signing up outside of your Initial Enrollment Period comes with a late penalty.
The penalty is an increase in price for your monthly premium. That increased price is applied for as long as you have Part B coverage.
Should I Defer Enrollment in Part B?
While most people choose to enroll in Medicare Part A regardless of additional insurance coverage (such as from an employer), the decision can be a bit more complicated for Medicare Part B.
This is because Part B comes with monthly premium costs, whereas Part A is premium-free.
For this reason, some people choose to defer Part B enrollment.
This decision is often influenced by personal factors like your current insurance coverage, employment status, as well as your personal financial, healthcare, and lifestyle needs.
Weighing these different elements and their priority or necessity to your current situation can help you with this decision.
You should keep in mind, however, that even if you have private insurance, you could still enroll in Part B.
Your Medicare Part B coverage can be used in coordination with your current coverage to reduce your spending.
Remember, this thinking only applies to those with some other current form of insurance.
If Medicare is your primary coverage, then Part B is strongly recommended to achieve adequate healthcare coverage.
Penalty for Late Enrollment in Part B
Generally, if you don’t sign up for Part B during your Initial Enrollment Period, you will have to pay a penalty for late enrollment.
However, if you qualify for a Special Enrollment Period, this penalty will not apply.
Note: A common way to qualify for a Special Enrollment Period is choosing to work past the age of 65.
When your employment ends, you can enroll in Part B during your Special Enrollment Period penalty free.
Your monthly premium cost goes up 10 percent for every 12-month period you didn’t enroll in Part B while eligible.
This penalty follows you for as long as you have Part B. The 10 percent increase is only applied after a full 12-month period.
So, even if you waited 2 years and 11 months to enroll during General Enrollment, you would still only receive a late enrollment penalty for 2 full 12-month periods.
What Does Medicare Part B Cover?
When you sign up for Medicare Part B, you receive coverage for both medically necessary services and preventive services.
This includes some of the more expensive services you might experience during a hospital stay, such as surgery, radiation, diagnostic imaging, chemotherapy, and dialysis, among others.
Part B covers preventive medical services like ambulance rides, doctor visits, screenings, and diagnostic tests.
It also covers a number of preventive care measures such as flu shots, colonoscopies, and mammograms.
Medically Necessary Services:
Medically necessary services and supplies are those used for diagnosis and treatment of medical conditions.
These services and supplies must meet the accepted standards of medical practice.
This includes the use of medical equipment like wheelchairs, hospital beds, and oxygen equipment.
Preventive Services:
Preventive services are those that prevent illness or detect it early enough for optimal treatment. This includes diagnostic tests like MRIs, EKGs, CT scans, and X-rays.
It also applies to covered screenings such as pap tests, HIV screening, glaucoma tests, hearing tests, diabetes screening, and colorectal cancer screenings.
If your healthcare provider accepts assignment, you often don’t have to pay anything for these preventive services.
How to Tell If Part B Covers What You Need
1. Consult with your doctor or health care provider to find out if Medicare covers your needed services or supplies.
In some cases, you may require something that is typically covered by Medicare but your provider isn’t sure if coverage will extend in your specific situation.
If this happens, you can sign a notice that says you may be required to pay for the test, item, or service.
2. You can also always search your Medicare coverage by test, item, or service at this Medicare.gov coverage page.
Remember: Your Medicare coverage will be based on federal and state laws, national coverage decisions by Medicare, and local coverage decisions made by Medicare claims processors in each state.
How Much Does Medicare Part B Cost?
Your 2023 Part B Premium:
For most new enrollees, your 2023 Part B monthly premium is $164.90.
Your premium amount is based on your annual income, so if your income exceeds $97,000 ($194,000 for married couples), then your premium will be higher than this.
To determine your premium amount, Medicare uses the modified adjusted gross income listed on your 2021 tax return (from two years ago).
Here’s a breakdown of the income brackets and their corresponding monthly premium:
Part B monthly premium cost if you file an individual tax return:
$97,000 or less = $164.90
Above $97,000 and up to $123,000 = $230.80
Above $123,000 and up to $153,000 = $329.70
Above $153,000 and up to $183,000 = $428.60
Above $183,000 and less than $500,000 = $527.50
$500,000 and above = $560.50
Part B monthly premium cost if you file a joint tax return:
$194,000 or less = $164.90
Above $194,000 and up to $246,000 = $230.80
Above $246,000 and up to $306,000 = $329.70
Above $306,000 and up to $366,000 = $428.60
Above $366,000 and less than $750,000 = $527.50
$750,000 and above = $560.50
If you’re already receiving benefits from Social Security, the Railroad Retirement Board, or the Office of Personnel Management then your premium is automatically deducted from your payment amount.
To learn more about the Part B Premium read our 2023 Guide.
Your 2023 Part B Deductible:
Your Part B annual deductible for 2023 is $226.
This means that once you have paid this amount (for Part B covered services), your Part B coverage will kick in.
You will then start to pay 20% of the Part B covered services going forward that year.
These Medicare-approved services might include options such as:
Outpatient therapy
Most doctor services (including hospital inpatient doctor services)
Durable medical equipment (such as wheelchair, walker, or hospital bed)
To learn more about the Part B Deductible read our 2023 Guide.
How to Pay Your Part B Premium
If you’re already receiving benefits from Social Security or the Railroad Retirement Board, then your Part B premium will automatically be deducted from your benefit payment.
If you’re not already receiving these benefit payments, then you’ll need to take care of your Part B premium.
How Often Will I Receive a Premium Bill?
If your Part A coverage is premium-free (and it is for most people), then you will receive a Part B premium bill every 3 months.
Here are the different options available for paying your Medicare premium bill:
Pay online with your credit or debit card.
You can do this at your MyMedicare.gov account. If you don’t already have an account, you can create one by following the guide on the homepage.
When you pay at MyMedicare.gov, you will need your card information and a copy of your premium bill to reference the correct payment amount.
On your card statement, the payment will show as “CMS Medicare”.
Unfortunately, there is not an option to set up recurring monthly payments through MyMedicare.gov. You will have to visit the site to pay each month.
Pay online with your savings or checking account.
You may be able to set a direct payment from your savings or checking account if your bank offers an online bill payment service.
Check your account options or with your bank to determine what information you will need to set up a monthly automatic bill payment.
Pay online with Medicare Easy Pay.
Medicare Easy Pay is a free payment service for your Medicare premium payments.
Once you sign up, the service automatically deducts your premium payment each month from the savings or checking account that you designated.
This payment usually takes place on the 20th of the month.
If you want to sign up for Medicare Easy Pay:
Complete this Authorization Agreement for Pre-authorized Payments Form from the CMS website.
Mail the form to:
Medicare Premium Collection Center
PO Box 979098
St. Louis, MO 63197-9000
This form can take about 6 – 8 weeks to process. Once complete, you’ll receive notifications when the deductions take place.
Medicare Easy Pay will always take out the correct and current premium amount that you owe, even if this amount changes over time.
Important Note: If your bill comes from the Railroad Retirement Board (RRB), then you cannot use Medicare Easy Pay for payment. Your premium payments must be sent to:
RRB, Medicare Premium Payments
PO Box 979024
St. Louis, MO 63197-9000
Mail in your payment.
When you receive your premium bill in the mail, a payment coupon will accompany it. Fill out all the necessary information on the coupon.
You can make your payment by check, money order, credit or debit card.
Make sure to include the coupon along with your payment. Payments that are received without the coupon might not be processed.
Mail your premium payment and coupon to:
Medicare Premium Collection Center
PO Box 790355
St. Louis, MO 63179-0355
What If My Part B Premium Payment Is Late?
If you’re late on your Part B premium payment, you’ll receive a second bill that includes the past due amount and the next month’s premium amount.
If the total amount presented on this second bill is not paid by the 25th of the month, you’ll receive a delinquent bill.
If you fail to pay the total amount presented on this delinquent bill by the 25th of the month, you’ll lose your Medicare Part B coverage.
If you have questions about your bill or the status of your coverage:
Call Social Security: 1-800-772-1213 (TTY: 1-800-325-0778)
If you have questions about your premium bill amount or Part B status:
Call Medicare: 1-800-633-4227
Opmerkingen