Medicare Part B Coverage: An Expert Guide (2024)

Medicare includes coverage from four different plans (Medicare Part A, Medicare Part B, Medicare Part C, and Medicare Part D) that cover various services. When you enroll in Medicare health insurance, you should understand what each part covers and how much they cost.

If you’re wondering, “What is Medicare Part B?” read below to learn about what it covers, how much it costs, and whether you qualify for coverage.

Enter your ZIP code into our free quote comparison tool above to find affordable health insurance or a supplemental Medicare plan from a company near you.

What is Medicare Part B?

Medicare Part B is one of the primary parts of Medicare. Medicare Part B provides coverage for doctor’s visits and outpatient care. Part B may also cover preventative services. Medicare Part A and Part B make up what is known as Original Medicare.

Medicare Part B is optional, but most people qualify for the coverage at some point. If you are older than 65, have a disability, or have End-Stage Renal Disease, you meet Medicare Part B eligibility requirements.

What does Medicare Part B cover?

The services that Medicare Part B covers can be split into two categories: medically necessary health services and preventative services.

Medicare Part B will cover the following:

• Clinical research studies
• Ambulance transportation when medically necessary
• Durable medical equipment (DME), such as blood sugar meters and test strips, canes and crutches, CPAP devices, hospital beds, infusion pumps and supplies, oxygen equipment, walkers, wheelchairs, and more
• Outpatient mental health services, such as depression screenings, therapists that accept Medicare, family counseling, psychiatric evaluation, diagnostic tests, and more
• Some outpatient prescription drugs, such as medications used with DMEs, antigens, osteoporosis injections, blood-clotting factors, oral End-Stage Renal Disease (ESRD) drugs, and more

If you have questions about whether Medicare Part B will cover a specific service or product, you may begin by talking with your doctor. Your doctor may be able to work with you to make sure your treatment is covered.

You can also use the Medicare coverage search to see the details of your coverage.

How much does Medicare Part B cost?

There is a monthly premium that you must pay for Medicare Part B. If you receive benefits from Social Security, the Railroad Retirement Board, or the Office of Personnel Management, your premium will be automatically taken out of your benefit payment.

If you don’t receive benefits, you will receive a bill for your premium. While most people pay the standard premium for Medicare Part B, some people who earn more will pay an Income Related Monthly Adjustment Amount (IRMAA) using your IRS tax return from two years ago.

The standard premium for Medicare Part B is $170.10 per month in 2022. However, the premium can go up to $578.30 per month based on your income.

The deductible for Medicare Part B is $233 in 2022. After you pay this deductible, you will be responsible for 20% of the Medicare-Approved Amount for most doctor services, outpatient therapy, and durable medical equipment (DME).

How do I receive Medicare Part B?

Some people who meet the eligibility requirements for Medicare Part B may be enrolled automatically, or you may need to apply manually.

For example, if you receive retirement or disability benefits, you will be enrolled automatically since your benefits application also serves as your Medicare application.

People in these groups who are automatically enrolled have the option to delay their Medicare Part B coverage.

If you do not receive benefits but would like to apply for Medicare Part B, you can do so once you meet specific eligibility requirements. For example, people who are turning 65 can apply up to three months before turning 65. In addition, those who have End-Stage Renal Disease can apply at any time.

The initial Medicare Part B enrollment period for those turning 65 begins three months before they turn 65, includes their birthday month, and ends three months after their birthday.

Open enrollment for Medicare occurs from October 15 to December 7. During this time, people can switch between Original Medicare and Medicare Part C or add or change Medicare Part D plans.

General enrollment for Medicare occurs from January 1 to March 31. During this time, people can apply for Medicare if they did not do so during their initial enrollment period.

Some people may receive special enrollment periods if they decide to delay their enrollment for an approved reason.

Should I get Medicare Part B?

While people can choose whether to enroll in Medicare Part A, it is not an option to enroll in Social Security or Medicare Part B.

Do you need Medicare Part B? You will need to pay for Medicare when you turn 65, and will be required to enroll in Medicare Part B unless you already have health insurance from you or your spouse’s employer. After the health insurance policy ends, you will be required to enroll in Medicare Part B.

If you need help finding affordable health insurance or a supplemental Medicare plan, enter your ZIP code into our free quote comparison tool below to get quotes from companies near you.

Case Studies: Medicare Part B Coverage

Case Study 1: Johnson Insurance Company

Mary Thompson, a 65-year-old retiree, enrolled in Medicare Part B after retiring from her job. She had a pre-existing medical condition that required regular visits to specialists. Mary found that Medicare Part B covered a significant portion of her healthcare costs, including doctor visits, diagnostic tests, and durable medical equipment.

However, she discovered that certain services, such as dental and vision care, were not covered. Mary supplemented her coverage by purchasing additional dental and vision insurance through Johnson Insurance Company, ensuring comprehensive care for her specific needs.

Case Study 2: BrightHealth Insurance

John Davis, a 68-year-old Medicare beneficiary, required frequent physical therapy sessions due to a chronic condition. He opted for Medicare Part B coverage to access the necessary rehabilitation services. Initially, John faced some challenges when it came to obtaining coverage for his therapy sessions.

However, with the assistance of BrightHealth Insurance, he successfully appealed the denials and received the coverage he deserved. This case highlights the importance of understanding the appeals process and working with an insurer that can advocate for the beneficiary’s rights.

Case Study 3: Golden Health Insurance

Sara Johnson, a 70-year-old Medicare recipient, sought Medicare Part B coverage to address her ongoing arthritis pain. She found that Medicare Part B covered most of her physician visits, laboratory tests, and outpatient treatments. However, when she required a new medication prescribed by her doctor, she discovered that it was not on the Medicare Part B formulary.

Sara worked with Golden Health Insurance to explore alternative medications covered under her plan, ultimately finding a suitable alternative that helped manage her arthritis symptoms effectively.

Case Study 4: Liberty Insurance Company

Mike Adams, a 72-year-old Medicare beneficiary, required regular medical equipment, including a wheelchair and oxygen supplies. With Medicare Part B coverage, Mike was able to access the necessary durable medical equipment.

However, he faced challenges when he needed replacements or repairs. Mike contacted Liberty Insurance Company, which guided him through the process of obtaining timely replacements and repairs, ensuring that his healthcare needs were met without interruption.

Case Study 5: Sunrise Health Insurance

Lisa Rodriguez, a 67-year-old Medicare enrollee, underwent surgery for a cardiac condition. She found that Medicare Part B covered a significant portion of her hospital stay, doctor fees, and post-surgical care. However, Lisa incurred additional costs for prescription medications she required during her recovery period.

Sunrise Health Insurance provided Lisa with valuable information about Medicare Part D prescription drug coverage, allowing her to enroll in a suitable plan and reduce her out-of-pocket expenses for medications.