Medicare Part B

Doctor Visits/Outpatient Care

Medicare Part B helps to pay for physician services, outpatient services, durable medical equipment and other medical services such as inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, and diagnostic tests. Generally speaking, you are eligible to apply for Part B starting three months prior to the month of your 65th birthday and up until three months following the month of your 65th birthday.

What Part B Helps Cover:

  • Services from doctors and other health care providers
  • Outpatient care
  • Home health care
  • Durable medical equipment (like wheelchairs, walkers, hospital beds, and other equipment)
  • Many preventive services (like screenings, shots or vaccines, and yearly “Wellness” visits)

What Part B Does Not Cover:

  • Any service not considered medically necessary (Fitness programs, alternative medicine, cosmetic and elective surgery)
  • Routine vision, hearing and dental services – includes checkups, eyeglasses, hearing aids, dental extractions, and dentures
  • Routine foot care services such as toenail clipping or corns and callus removal (unless your foot problems are due to medical conditions such as diabetes, cancer, multiple sclerosis, chronic kidney disease, malnutrition or inflammation of the veins related to blood clots)
  • Long-term care in nursing homes or assisted living facilities
  • Daily activities such as dressing, feeding, bathing, and going to the bathroom
  • Home safety items (medical emergency alert systems, bathroom grab bars, bathtub lifts or seats, elevators or stair lifts)
  • Medical services outside the United States (except in rare circumstances)

How much does Part B coverage cost?

The standard Part B premium amount in 2020 is $144.60. Most people pay the standard Part B premium amount. If your modified adjusted gross income (AGI) as reported on your IRS tax return from 2 years ago is above a certain amount, you’ll pay the standard premium amount and an Income Related Monthly Adjustment Amount, also known as IRMAA. IRMAA is an extra charge added to your premium. Go to www.medicare.gov/your-medicare-costs/part-b-costs or call 1-800-MEDICARE (1-800-633-4227, TTY users call 1-877-486-2048) for more information..

What’s the Part B late enrollment penalty?

If you don’t sign up for Part B when you’re first eligible, you may have to pay a late enrollment penalty for as long as you have Part B. Your monthly premium for Part B may go up 10% for each full 12 months in the period that you could’ve had Part B, but didn’t sign up for it. If you’re allowed to sign up for Part B during a Special Enrollment Period, you usually don’t pay a late enrollment penalty. For example, if you wait to sign up for Part B for 24 months after the Initial Enrollment Period (IEP), the premium penalty will be an additional 20% on your monthly Part B premium as long as you continue to have Part B.

What’s the Part B Deductible and coinsurance?

Part B carries an annual $198.00. This deductible only counts towards Medicare approved amounts. After your deductible is met, you typically pay 20% (coinsurance) of the Medicare-approved amount, while Medicare pays 80% for most doctor services (including most doctor services while you’re a hospital inpatient), outpatient therapy, and durable medical equipment (DME).

For more information, go to this webpage: www.medicare.gov/your-medicare-costs/medicare-costs-at-a-glance.

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