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Medicare Part B: Understanding Medicare's Medical Insurance
By Donna Frederick
May 20, 2020
Medicare Part B generally covers two main types of service. The first is medically necessary services and supplies that are needed to treat or diagnose your medical condition. These must also meet accepted standards of medical practice.
The second type of service that Medicare Part B covers is preventive services to help discover issues early when treatment is most likely to work best. For example, some shots and vaccines are covered.
Part B Enrollment
You can enroll in Medicare Part B medical insurance during the Initial Enrollment Period, which begins three months before your 65th birthday and extends through the three months that follow your birth month. There is also a special enrollment period for those who are covered by a group health plan offered by a union or employer.
You will be automatically enrolled in Medicare Part B the first day of the month you turn 65 if you are already receiving benefits from Social Security or the Railroad Retirement Board. If your birthday is on the first of the month, you will enroll in Medicare Part B on the first day of the previous month. Anyone who is not receiving Social Security or RRB benefits for at least four months before they turn 65 must enroll in Medicare through Social Security.
If you are disabled and under the age of 65, you will likely automatically get Medicare Part B once you receive Social Security disability benefits. Most people must pay a monthly premium, the cost of which may change depending on their income, to ensure Medicare Part B coverage. The premium is usually deducted from your monthly Social Security payments, depending on income.
If you were automatically enrolled in Medicare Part B and received a card in the mail, you can choose to opt out by sending the Medicare Part B card back: by keeping the card, you keep Medicare Part B and keep paying Medicare Part B premiums. If you signed up for Medicare through Social Security, contact Social Security.
Part B Penalties
If you don’t sign up for Medicare Part B when you’re first eligible, you have to pay a late enrollment penalty. For every one-year period that you were qualified to enroll in but opted not to, your Medicare Part B monthly premium increases by 10 percent. You pay this penalty for the entire time you have Medicare Part B. If you meet certain conditions that allow you to sign up during the Special Enrollment Period, you may not have to pay this enrollment penalty.
Part B Outpatient Care
Medicare Part B provides patients with medically necessary outpatient healthcare. Physician services, nursing services, vaccinations, cardiovascular and diabetes screenings, lab services, and other preventive services are all covered by Medicare Part B. In addition, Medicare encourages all beneficiaries to complete an annual Wellness Visit. Medicare Part B will not pay for cosmetic surgery, custodial care, prescription drugs, dental or vision care, as well as some other services.
Medicare does not cover every health-related service or item. You may have co-payments and deductibles on services even if they are covered by Medicare. After you meet your deductible, your co-payments will generally cost around 20% of the Medicare-approved amount for most doctor services. If a service you need is not covered by Medicare, you must cover the costs yourself unless you have separate insurance that does.
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