Medicare Part B – Major Medical Benefits

What is Medicare Part B?

Original Medicare Part B helps pay for two types of services and supplies:

  1. Those that are medically necessary refer to those needed to diagnose and/or treat your condition while meeting accepted standards of medical practice. Doctor’s visits fall under this category.

  2. Those that are preventive refer to health care to prevent illness (like the flu) or detect it at an early stage. Mammograms, diabetes screening, HIV testing are some of the preventive services. See preventive services for a list of preventative and screening services covered by Part B.

In General, What Else Does Part B Cover?

In general, Part B also helps pay for the following:

  • Clinical research
  • Ambulance services
  • Durable medical equipment
  • Mental health
    • Inpatient
    • Outpatient
    • Partial hospitalization
  • Getting a second opinion before surgery
  • Limited outpatient prescription drugs

Medicare Advantage Plans must give you at least the same coverage as Original Medicare.

What Are Some Items Specifically Not Covered by Medicare Part B?

Some of the items and services that Medicare does not cover include:

  • Long-term care (also called custodial care)
  • Routine dental or eye care
  • Dentures
  • Cosmetic surgery
  • Acupuncture
  • Hearing aids and exams for fitting them
  • Routine foot care

How Do I Know if What I Need is Covered by Part B?

Generally, there are two ways to check to see if your test, item or service needs will be covered. Before you assume you are covered:

  1. Talk to your doctor or provider and ask if your specific needs will be met.

  2. You can also Find out if Medicare covers your item, service, or supply to determine probable coverage.

What if My Needed Services Are Not Covered by Medicare Part B?

Simply stated, if you need certain services that Medicare doesn’t cover, you’ll have to pay for them yourself unless you have other insurance or you’re in a Medicare health plan that covers these services. Remember, even if Medicare covers a service or item, you generally have to pay your deductible, coinsurance, and copayments.

How Much Will Part B Cost in Premiums for 2013?

You pay a premium each month for Medicare Part B (Medical Insurance). Most people will pay the standard premium amount of $104.90. However, if your modified adjusted gross income (AGI) from 2 years ago is above a certain amount, you may pay more. See the following table.

If Your Yearly Income in 2011 Was

File Individual Tax Return   File Joint Tax Return   You Pay
$85,000 or less   $170,000 or less   $104.90
$85,001 – $107,000   $170,001 – $214,000   $146.90
$107,001 – $160,000   $214,001 – $320,000   $209.80
$160,001 – $214,000   $320,001 – $428,000   $272.70
$214,001 and above   $428,001 and above   $335.70

Social Security will contact some people who have to pay more. The amount you pay can change each year depending on your income. If you have to pay a higher amount for your Part B premium and you disagree (for example, if your income goes down), use this form to contact Social Security. To get more information about your Part B premium, get the Social Security Pamphlet: Medicare Premiums: Rules for Higher Income Beneficiaries.

Is There a Penalty if I Enroll in Part B Late?

Yes, with a caveat – see below.

You should sign up for Part B when you’re first eligible, to avoid paying a late enrollment penalty for as long as you have Medicare. Your monthly premium for Part B may go up 10% for each full 12-month period that you could have had Part B, but didn’t sign up for it. As a caveat, you don’t pay a late enrollment penalty if you meet certain conditions that allow you to sign up for Part B during a Special Enrollment Period.

What if I Need Help with Medicare Costs?

Medicare is insurance. As such, it can carry a monthly cost (your premium); annual deductibles (the amount you must pay each year before the insurance pays), and; co-pays (what you pay each time you get a service). If you are on a limited income, Medicare has programs that can help you pay these costs.

For more information, the programs below.

Program Description
Medicaid Medicaid is a joint federal and state program that helps with medical costs for some people with limited income and resources.
Medicare Savings Programs Learn about programs in your state that help pay your premiums, and in some cases, your deductibles, coinsurance, and copayments.
PACE PACE is a Medicare and Medicaid program that helps people meet their health care needs in the community instead of going to a nursing home or other care facility.
Save on drug costs If you meet certain income and resource limits, you may qualify for Extra Help from Medicare to pay the costs of Medicare prescription drug coverage.
Programs for people who live in U.S. territories There are programs in Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa to help people with limited income and resources pay their Medicare costs. Programs vary in these areas.
Find your level of Extra Help (Part D) To check the level of Extra Help you’re entitled to, you’ll need to provide some information.
Insure Kids Now The Children’s Health Insurance Program (CHIP) provides free or low-cost health coverage for more than 7 million children up to age 19. CHIP covers U.S. citizens and eligible immigrants.
Supplemental Security Income (SSI) The Supplemental Security Income (SSI) program pays benefits to disabled adults and children who have limited income and resources. SSI benefits also are payable to people 65 and older without disabilities who meet the financial limits.

Medicare Medical Benefits