A Guide to Medicare Part B Coverage

A Guide to Medicare Part B Coverage

In 2019, more than 61 million people received health care coverage through Medicare, the federal health insurance program for people 65 and older, according to the Centers for Medicare and Medicaid Services.


Medicare works a bit differently than private, employer-provided health plans do. One of the most critical differences is that Medicare is divided into two main parts: Medicare Part A, which is hospital insurance; and Medicare Part B, which provides medical insurance.


Medicare Part B coverage is important because it covers preventive care and routine care for diagnosed illnesses. You might rely on Part B more than you do Part A, which covers hospital stays; care in a skilled nursing facility, nursing home or hospice; and home health care. If you're set to turn 65 soon and are exploring your health care options, here's what you need to know about Medicare Part B.


What Does Medicare Part B Cover?


Medicare Part B covers two types of services: medically necessary services and preventive services.


Medically necessary services are what they sound like — services that are essential in diagnosing or treating medical conditions, such as diabetes, high blood pressure and cancer. These services must meet accepted medical and treatment standards, and they include clinical research, ambulance services, medical equipment and certain drugs.


Preventive services help prevent illness. They include annual physicals, mammograms, colon cancer screenings and immunizations. You don't pay any out-of-pocket costs for preventive services if you see a doctor who accepts Medicare.


Who's Eligible for Medicare Part B Coverage?


To be eligible for Medicare Part B, you must be at least 65 years old.


If you're already receiving Social Security benefits, you'll automatically receive Medicare parts A and B the first day of the month you turn 65. But if you'll be turning 65 and won't be collecting Social Security, you'll have to sign up for Medicare during a seven-month window: the three months before you turn 65, the month you turn 65 and the three months after you turn 65. (Note, though, that your coverage could be delayed if you wait until the month you turn 65 to sign up.) You don't have to sign up for Medicare Part B when you're first eligible, but if you don't, you might have to pay a late enrollment penalty.


Part B comes with a monthly premium and deductible. In 2021, the standard monthly premium is $148.50, and the annual deductible — what you pay out-of-pocket before health insurance begins covering costs — is $203. Premiums can be deducted from your Social Security benefits. If you don't receive Social Security benefits, you'll receive a bill — but Medicare is usually more affordable than private health insurance.


It's possible to carry private insurance and Medicare Part B simultaneously, but it can get complicated knowing which insurance program pays for which services. Generally, if you're still employed or covered by your spouse's plan, that employer-based plan will pay first, and Medicare will pay the rest. But the rules vary depending on the size of the company offering the policy; consult Medicare's Benefits Coordination and Recovery Center for clarity if you plan to keep your private insurance.


Is Medicare Part B Enough for Your Health Care Needs?


Though Medicare covers a range of services, whether this coverage is enough will depend on your health and your needs, especially if you have a chronic condition that requires ongoing treatment. The Centers for Medicare and Medicaid Services releases an annual handbook, Medicare and You, that covers Medicare in great detail; review it to determine whether Medicare will cover the specific tests, medications and services you need.


If Medicare doesn't provide enough coverage, you could enroll in a Medigap plan, a supplemental insurance plan that helps close coverage gaps and reduce out-of-pocket health care costs.


As you get older, your health needs will change. Medicare Part B provides affordable coverage for a range of health services. Before you sign up for Part B, make sure that you understand what's covered and how much it costs, and make sure that the coverage Medicare provides will be enough to get you the care you need.


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