Medicare Part B
Medicare Part B is a federal health insurance
program supplementary to Part A. This voluntary
program requires a premium and covers physician
and outpatient services. Here's a look at the Part B
Medicare Part B covers medically-necessary services and some preventive services that are not
covered by Medicare Part A. If you enroll in Part B, Medicare will pay 80% of the “reasonable charge” for
covered services after you’ve met the deductible for that year. You are responsible for paying the other
20% (co-insurance). Medicare has a defined “reasonable charge” for services that might be less than
what the doctor charges. In that case, you’ll be responsible for paying 20% plus the difference between
the actual cost of service and Medicare’s reimbursement. Some doctors may accept assignment,
meaning they’ll only charge Medicare’s “reasonable charge” for services, leaving you to pay the 20% co-
Who Can Receive Medicare Part B?
You can receive Medicare Part B if you are a U.S. citizen and:
- You are over 65, or
- You are under 65 and have certain disabilities, or
- You have End-Stage Renal Disease
How Much Does Part B Cost?
You are responsible for paying the Part B premium every month. The standard premium for 2009 is
$96.40. You may have to pay a higher premium based on your income if you file single on your tax return
and your modified adjusted gross income (MAGI) is higher than $85,000. For married filing jointly, the
MAGI limit is $170,000. Individuals and couples who exceed the minimum income limits could pay as
much as $308.30 a month.
If you don’t sign up for Part B when you are first eligible for it, your premium could be 10% higher for that
In 2009, you must meet a $135 deductible before Medicare will begin paying its share of coverage.
Part B Automatic Enrollment
If you receive Social Security or Retired Railroad Board (RRB) benefits, you
will automatically receive Part B on the first day of the month you turn 65. Your
Medicare card will come in the mail 3 months before your 65th birthday. If you
are under 65, you will receive Part B after you’ve received disability benefits
from Social Security or RRB for 24 months. Your Medicare card will come in
the mail on the 25th month of your disability.
Though you are automatically enrolled in Part B under the previously
mentioned circumstances, you don’t have to keep it. If you don’t want Part B,
your card will come with instructions on cancelling it. Follow those
instructions and send the card back. If you keep the card, you will pay
Medicare part B premiums. Premiums are automatically deducted from your
Social Security or RRB benefits.
How to Sign Up for Medicare Part B
If you would like to receive Part B, but you’re not receiving Social Security or
RRB benefits, you can sign up during the initial enrollment period which
starts 3 months before the month you turn 65 and ends 3 months after you
You can also sign up for Part B during the general enrollment period from
January 1 to March 31 each year and your coverage will begin on July 1 of
that year. Note, if you missed the signup during your initial enrollment period,
you could face a 10% increase in your monthly premium.
There are special enrollment periods for those who waited to sign up for
Medicare because they had group health insurance or health insurance while
serving as an international volunteer. You can sign for Part B any time that
you or your spouse has group plan coverage from an employer. You can also
sign up a maximum of 8 months after employment ends or group health plan
coverage ends, whichever is first. International volunteers can sign up a
maximum of 6 months after the volunteer assignment ends.
What Services Does Part B Cover
Part B services include, but are not limited to:
- Doctor services that are medically necessary
- Emergency ambulance services and some non-emergency transportation under doctors orders
- Fees for approved ambulatory surgical centers
- Some preventative services
- Clinical laboratory services
- Qualifying clinical research studies
- Defibrillator for those diagnosed with heart failure
eye exams for people with diabetes, foot treatment
- Diabetes screenings for those with certain risk factors, diabetes self-management supplies,
use in your home
- Certain medical equipment (e.g. oxygen equipment and supplies) ordered by your doctor for
- Eyeglasses after cataract surgery
- Outpatient primary care and preventive in a federally-qualified health center
- Hearing and balance exams as ordered by your doctor
- Certain vaccinations and screenings for those with risk factors
- Pap tests, pelvic exams, and clinical breast exams
- Certain prescription drugs
- Speech pathology services
- Surgical dressing services
You can find out more about Medicare Part B by contacting your local Social Security office or by visiting
the Medicare website www.medicare.gov.
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