What Does Medicare Part B Cover?

Medicare Part B (which is medical insurance) is part of Original Medicare and covers medical services and supplies that are medically necessary for treating your health condition. This may include outpatient care, preventive services, ambulance services, and durable medical equipment (DME). It will also cover part-time or intermittent home health and rehabilitative services, like physical therapy, if they are prescribed by a doctor for treating your condition.

Medicare Part B also covers more expensive services that sometimes occur in the hospital. This includes services like radiation or chemotherapy for cancer, surgeries, diagnostic imaging, medical equipment, and even dialysis for failing kidneys. Part B will also pay for drugs administered in a clinical setting, like osteoporosis injections, infused drugs, antigens, and insulin that is used with an insulin pump. Otherwise, outpatient drugs fall under Part D.

Some preventive services are also covered by Medicare Part B including a one-time “Welcome to Medicare” preventive visit, flu and hepatitis B shots, cardiovascular screenings, cancer screenings, diabetes screenings, colonoscopies, mammograms, and more. For a full list of the preventive services covered under Medicare Part B, please refer to the Medicare handbook, “Medicare and You.”

Of course, Part B is optional, however, if Medicare is your primary coverage, you need Part B.  Also, you cannot get Medigap supplemental coverage without it.

Medicare Part B covers 80% of approved costs after you first pay the annual deductible.

Eligibility for Medicare Part B

Whoever is eligible for premium-free Medicare Part A is eligible for Medicare Part B by enrolling and paying a monthly premium. If you are not eligible for premium-free Medicare Part A, you can qualify for Medicare Part B by meeting the following requirements:

• You must be 65 years or older.
• You must be a U.S. citizen, or a permanent resident lawfully residing in the United States for at least five consecutive years.

You can also qualify for automatic Medicare Part B enrollment through disability. If you are under 65 and receiving Social Security or Railroad Retirement Board (RRB) disability benefits, you will automatically be enrolled in Medicare Part A and Part B after 24 months of disability benefits. You may also be eligible for Medicare Part B enrollment before 65 if you have the end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (also known as ALS, or Lou Gehrig’s disease).

When to enroll in Medicare Part B

If you are receiving retirement benefits before age 65 or qualify for Medicare through disability, generally you’re automatically enrolled in Medicare Part A and Part B as soon as you become eligible.

If you do not enroll during your initial enrollment period and do not qualify for a special enrollment period, you can also sign up during the annual General Enrollment Period, which runs from January 1 to March 31, with coverage starting on July 1. You may have to pay a late enrollment penalty for not signing up when you were first eligible.

If you’re not automatically enrolled, you can apply for Medicare through Social Security, either in person at a local Social Security office, through the Social Security website, or by calling 1-800-772-1213 (TTY users 1-800-325-0778) from 7 AM to 7 PM, Mon through Fri.

Keep in mind that once you are both 65 years or older and have Medicare Part B, your six-month Medigap Open Enrollment Period will begin. This is the best time to purchase a Medicare Supplement (Medigap) insurance plan because, during the open enrollment, you will have a “guaranteed-issue right” to buy any Medigap plan without medical underwriting or paying a higher premium due to pre-existing conditions. Once you are enrolled in Medicare Part B, be careful not to miss this one-time initial guaranteed-issue enrollment period for a Medicare Supplement.

Delaying Medicare Part B enrollment

Some people may get Medicare Part A “premium-free,” but most folks have to pay a monthly premium for their Medicare Part B. Because Medicare Part B comes with a monthly premium, some people may choose not to sign up during their initial enrollment period if they are currently covered under either their own or through their spouse’s employer, an employer health group plan (EGHP).

If you are still employed, you should check with your health benefits administrator to see how your insurance would work with Medicare. If you delay enrollment in Medicare Part B because you already have current employer health group coverage, you may sign up later during a Special Enrollment Period (SEP) without paying a late penalty. You can enroll in Medicare Part B at any time that you are still covered by a group plan based on your current employment. After your employer’s health coverage ends or your employment ends (whichever comes first), you have an eight-month SEP to sign up for Part B without incurring a late enrollment penalty.

Keep in mind that retiree coverage and COBRA are not considered health coverage based on current employment and would not qualify you for a SEP. If you have COBRA after your employer coverage ends, you should not wait until your COBRA coverage ends to sign up for Medicare Part B. Your eight-month Part B special enrollment period begins immediately following when your current employment or group plan ends (whichever comes first). This is regardless of whether you get COBRA.