Along with Part A, Medicare Part B is one of the original parts that President Lyndon Johnson signed into law in July 1965. Medicare Part B services are pretty basic and easy to understand.
So what’s covered?
Medicare Part B: What it covers
In general, Medicare Part B covers your doctor’s office visits, plus such additional services as lab tests and equipment such as wheelchairs. There are two types of Part B services:
- Medically necessary services. Services and supplies necessary to diagnose or treat your medical condition and that meet acceptable standards of medical practice.
- Preventive services. Your annual wellness visits and services to detect or treat illnesses in the early stages are covered, along with clinical research, ambulance services, durable medical equipment, mental health, a second opinion before surgery, and some out-patient prescription drugs. Medicare Part D covers most prescription drugs, but Medicare Part B covers some, including injectable chemotherapy drugs as long as they’re administered in a physician’s office.
What about deductibles?
Medicare Part B has a $147 annual deductible – the amount you would pay out-of-pocket in a given calendar year before benefits kick in. The Part B deductible goes from January through December, unlike Part A, which is applied for each 60-day benefit period.
How Part B works
When you’ve met the deductible, Medicare pays 80 percent of the approved amount. So let’s say you’ve visited your doctor and/or received a covered medical service. The doctor or service provider will submit a claim to Medicare, who will approve a certain amount of the charge and pay the doctor/provider 80 percent of the approved amount.
And the additional charges?
Medicare determines the charges and the approved amounts. A Medicare Supplement plan will pay the additional 20 percent, and some supplements such as Plan F will pay the Part B excess – the difference between the original charge and what Medicare approved. When you’re exploring Medicare Supplement plans, check to see which plans offer coverage to pay the Part B deductible. Some do. Some don’t. If you’re looking for a lower premium, you might choose a plan that doesn’t cover the deductible.
What it costs
Medicare Part B premiums are based on your yearly income and deducted from your Social Security benefit. For individuals earning up to and not more than $85, 000 or couples earning up to but not over $170,000 annually, the base premium is $104.90. Your income is based on your tax return going back two years. So if you become eligible for Medicare in 2020, the government will look at your tax return from 2018.
For 2015, Part B has five income brackets ranging to $214,000 and above for singles and $428,000 and above for a joint tax return that determine your premium. For more details about premium costs, you can go to the Part B Costs section of the Medicare website.
If your income shifts between brackets
If your income puts you in another bracket – up or down – Medicare will catch it when it reviews your income each year. If a qualifying life-changing event has caused your income to drop, you should get a notice that your premium includes an income-related monthly adjustment amount (IRMAA). You also can notify Social Security proactively. Qualifying life-changing events include marriage, divorce/annulment, death of your spouse, work stoppage, work reduction, loss of income-producing property, loss of pension, and income employer settlement payment. To appeal your Part B premium, you’ll need to submit Social Security form SSA-44. Print it out from the Social Security website or visit your local Social Security Office.
More information
As always, your experienced team at Stateside Insurance is here to answer your questions. To request a copy of the Medicare bulletin “Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare,” call us at 866.444.3332 or email us at info@texasplans.com.
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