Medicare Part B: A Primer

Medicare Part B helps cover medically necessary services, preventive care and other health-related expenses. This includes routine visits to the doctor’s office, outpatient care, diagnostic tests, laboratory tests, addiction treatment and behavioral health.

In short, while Medicare Part A covers emergency care and hospital stays, Part B covers medically necessary services outside a hospital, as well as preventative care to keep you on a healthy path. Things such as wellness checks, durable medical equipment – like diabetes tests, oxygen tanks, or wheelchairs and walkers – as well as the costs of using an ambulance, are all covered under Part B. Insulin pumps are also covered under Part B’s durable medical equipment benefit.

Medicare Part B coverage is an invaluable asset for those over the age of 65. However, it does come with a cost. The standard monthly premium for Medicare Part B in 2023 is $164.90, a decrease of $5.20 from $170.10 in 2022. The annual deductible for all Medicare Part B beneficiaries is $226 in 2023, a decrease of $7 from the annual deductible of $233 in 2022, although the actual amount you pay may vary depending on your income level.

In addition, you’ll usually pay 20% of the cost for each Medicare-covered service or item after you’ve paid your deductible – often referred to as co-insurance. Still, while no one enjoys paying a premium or other costs out of pocket, these amounts are still very reasonable considering the high number of health issues many seniors have every year, not to mention risks of serious illness or injury.

Typically, you pay this premium directly to Medicare out of your Social Security check each month. However, if you are covered by Medicaid or another state program, that organization may cover your monthly Part B premium instead. It’s important to keep in mind that there may also be additional fees associated with getting care from providers outside the original Medicare network.

Signing up for Medicare Part B is an important step that needs to be taken as you approach your 65th birthday. If you are already receiving Social Security or Railroad Retirement Board benefits, then you should automatically be enrolled in Part B coverage on the first day of your birthday month. If not, then you can sign up during your Initial Enrollment Period (IEP), which begins three months before you turn 65 and ends three months after you turn 65.

If you miss the IEP, you can sign up during the General Enrollment Period (GEP) held from January 1 to March 31 each year, though you may face a late enrollment penalty. However, coverage does not begin until the first of the following month that you enroll in during the GEP. In addition, your premium may be 10% higher than if you had enrolled on time. Moreover, late enrollees may have to wait significantly longer for their coverage to begin as reviews or appeals must be processed before benefits are available.

Most importantly, by waiting months to enroll you risk being without health insurance for a significant amount of time, during which any number of health issues or injuries can arise. So it is always best to enroll in Medicare Part B as soon as you can once you reach eligibility age.

Even with low premiums and out of pocket expenses, many senior citizens are on a fixed income and need financial help. Luckily, there are some options that may help offset the costs.

Individuals who have limited income and resources may qualify for extra help from Medicare to pay for some of their costs. Additionally, depending on your circumstances, you may be able to get your state Medicaid program, or State Health Insurance Assistance Programs (SHIP) to provide financial assistance for medical expenses covered by Medicare Part B. Finally, there are also multiple non-profit charitable organizations that might be able to help.

As always, it is important to speak with a Medicare professional like those at Insurance Professionals of Arizona before trying to enroll on your own. A Medicare expert will help guide you through the entire enrollment process, and make sure you have all the coverage you need, at a cost within your budget, even if you are on a fixed income.