Medicare Part B

Outpatient & Preventative Services

COVERAGE – Outpatient Services

Medicare Part B provides coverage for most preventative care and necessary medical services. Included in Part B are general outpatient services, such as doctor visits, vaccinations, health screenings, preventative care, wellness visits, chiropractic care, and other medically necessary services and supplies to diagnose or treat your medical condition.

 

You’ll also be covered in the event an ambulance is required for transportation, or you need outpatient hospital services like radiation, chemotherapy, surgery, medical equipment, administration of medications in a clinical setting (insulin used with an insulin pump, infused drugs, certain injections, etc.), diagnostic imaging, or dialysis treatments.

 

Not Covered Under Part B

While we know Part A covers all inpatient hospitals and longer-term medical services, Part B is not meant to cover every other service you may need or want. Among the services not included under Part B are: Regular dental, vision, and hearing appointments; podiatrist services; prescription drugs; and other unnecessary medical procedures, such as cosmetic treatment or operations.

 

If your eyebrows raised when reading prescription drugs weren’t covered, you need not worry. This coverage is available under Medicare Part D.

 

Costs

To begin, you will pay a monthly premium for Medicare Part B, which is determined by the government and also based on your income level (the standard 2021 monthly rate is $148.50 for new Medicare enrollees). If you are drawing Social Security, your monthly premium will be deducted from your check; otherwise, you will receive a bill every three months.

 

Cost-Sharing

Medicare Part B will require you to pay an annual deductible ($203 for 2021), as well as 20% of the Medicare-approved services received. You will also be responsible to cover the full cost of any services or charges that are not Medicare-approved.

 

As you can see, while the premium rate is manageable, outpatient expenses can become significant depending on the medical care received. It is always recommended to have up-front discussions with your provider to best understand what is covered by Medicare, the potential out-of-pocket costs of services, and if alternative remedies may be available to minimize your financial obligation.

 

Offsetting Costs

If you know your healthcare needs will be substantial, consider Medigap policies (supplemental Medicare coverage), which will assist in covering costs Parts A and B do not. You can also explore the benefit of Medicare Advantage Plans (Part C), which will require you to obtain coverage offered in Parts A and B through a private health insurance plan.

 

**Part B is required if you are interested in purchasing Medigap coverage.

 

Considerations

  • If Medicare is your primary insurance, be sure to enroll in Part A and Part B during your initial enrollment period to give you the broadest coverage possible.
  • Consult with your medical provider to understand the medically necessary services your health requires, which can assist you in preparing and planning financially for future expenses you may be responsible for. This will also help you determine if you benefit from Medigap coverage or if alternative supplement options should be explored.
  • Explore and determine your insurance options for vision, hearing, and dental services to stay current with preventative services.

 

Enrollment

Enrollment in Medicare Part B is optional in most cases, but we encourage you to sign up to help you get the most out of your Medicare coverage. Of greatest importance is avoiding late penalties for enrollment, which not only increase the longer you wait but also get added to your monthly premium.

 

If Medicare is your primary insurance, Part B is absolutely necessary to provide a balanced coverage approach for your healthcare needs.

 

Drawing Social Security

If you are already drawing Social Security Income by the age of 65, you will be automatically enrolled in Part B and will receive your Medicare card in the mail verifying your coverage. Be sure to keep an eye out for this 2 – 3 months before you turn 65, and then place it in a safe location.

 

If you are not taking Social Security, you can enroll in Part B through your Social Security office, over the phone, or online.

 

Still Employed

If you are still working and your employer has less than 20 employees, you are required to sign up for Medicare Part A and Part B at the age of 65.

 

Retired

If you have a retirement health plan, be sure to sign up for Medicare Part A and Part B during your eligibility period at the age of 65. Medicare will serve as your primary insurance, with your existing retirement health plan being your secondary. Having both will afford you considerable coverage for any healthcare services you incur.

 

Take the time now to learn about the initial enrollment period, to best avoid late penalties. General enrollment takes place from January 1 to March 31 each year, with other enrollment exceptions available depending on your situation.