Medicare Part B
(Medical Insurance)

Medicare Part B is you medical insurance. Medicare Part B covers things like doctors visits, lab services, durable medical equipment. Part B also covers things both in and out of the hospital when having outpatient medical procedures.




Medicare Part B Highlights

How it Works

Medicare Part A was first signed into law in 1965 to provide healthcare for US citizens over 65 years of age.  Medicare Part B was introduced to provide outpatient hospital services.

Eligibility

You are eligible to enroll in Part B when you turn 65 or 24 months after been collecting disability benefits, or if you have End Stage Renal Disease (ESRD)

Benefits

Medicare Part B covers your medical services, doctors visits, lab services, durable medical equipment, and more.


Premium Cost

For most, the monthly premium for Medicare Part B is $170.10 for 2022. However some people may have to pay Premium.



Enrollment

You are automatically enrolled in Part B if you are collecting Social Security Income (SSI) benefits at the time you become eligible for Medicare. Otherwise, you may have to apply to get
Part B.

Cost-Sharing

In addition to Part B monthly premium, Part B has deductibles, copays and coinsurance when you use services.



How does Medicare Part B Work?

How does Medicare Part B Work?

Medicare Part B was first signed into law in 1965 to provide healthcare for US citizens over 65 years of age. Medicare Part B was one among the two part of Original Medicare. In 1966 Medicare Part A became effective for more that 19 million US citizens. Medicare Part B was introduced to provide outpatient medical services. Outpatient services include most medical services such as hospital doctors visits, lab services, physical therapy, and more. For most people, monthly premium for Part B is $170.10 for most beneficiaries. With Part B, you are responsible to pay an annual deductible of $233 for 2022 first. Once you meet that deductible, you start paying coinsurance of 20% for all Part B covered services. Basically, Medicare pays 80% of the cost and you pay 20%.

Medicare Part B Eligibility

Medicare Part B Eligibility

You are eligible for Medicare Part B at age 65 as well. However, you can be eligible for Part B under the age of 65 if:

If you are in a situation where you would like to learn whether it is wise to give up your employer's healthcare insurance or not, you should meet with one of our Medicare Advisors to provide you guidance. There are many factors in play in the decision including premiums, out-of-pocket costs like deductibles, copays, medications costs and so forth. We will show the math and give you our expert opinion and the decision is your at the end.

Medicare Part B Benefits

Medicare Part B Benefits

Medicare Part B coverage provides you access to a variety of outpatient medical services. Part B covers preventive care including flu shots, colonoscopies, mammograms and more. It covers ordinary outpatient services like doctor’s visits, lab testing, home health care, ambulance rides, and some chiropractic care too.

However, Medicare Part B also covers services that sometimes occur in the hospital. This includes things like physician’s services, 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, such as osteoporosis injections, infused drugs, antigens, and insulin that is used with an insulin pump. Otherwise, outpatient drugs fall under Part D Prescription Drug Plan (PDP).

Part B is optional, but if Medicare is your primary coverage, you definitely need Part B. It is strongly recommended to add a Part C Medicare Advantage plan or Medicare Supplement (Medigap) plan to your Original Medicare to gain extra benefits.

Office Visits

Office
Visits

Emergency and Urgent Care Visits

Emergency and Urgent Care Visits

Lab Services

Outpatient Lab
Services

Durable Medical Equipment

Durable Medical
Equipment

Outpatient Surgical Procedures

Outpatient Surgical Procedures

Ambulance Services

Ambulance
Services

Diagnostic Radiology

Diagnostic
Radiology

Radiation and Chemotherapy

Radiation and Chemotherapy

Immunizations

Immunizations

Diagnostic Procedures

Diagnostic
Procedures

Part B does not cover Dental, Vision, and Hearing Aid Services, and Prescription Drugs.

Dental Services Not Covered

Dental Services

Vision Services Not Covered

Vision Services

Hearing Services Not Covered

Hearing Services

Prescription Drugs

Prescription Drugs

Medicare Part B Premium Cost

Medicare Part B Premium Cost

You must pay a monthly premium for your Medicare Part B benefits. The majority of US citizens will pay the standard monthly amount premium set by the government. In 2022, the base rate for Part B is $170.10/month for people new to Medicare. However, some people with higher income may have to pay higher premium for Part B. This is called the Income-Related Monthly Adjusted Amount (IRMAA).

You can find a chart showing the costs based on your income bracket on our Medicare costs page. If you enroll late into Part B, you may also have to pay a penalty for life. It’s important not to miss your enrollment window whenever you retire and lose access to your employer group health insurance.

The table below lists the 6 brackets for IRMAA and how much you owe for Part B 

Individual Income in
Year 2021		Joint Income in
Year 2021		2023 Part B
Monthly Premium
$97,000 or less$194,000 or less$164.90
> $97,001 – $123,000> $194,001 – $246,000$230.80
> $123,000 – $153,000> $246,001 – $306,000$329.20
> $153,001 – $183,000> $306,001 – $366,000 $428.60
> $183,001 – $500,000> $366,001 – $750,000 $527.50
Greater than $500,000Greater than $750,000$560.50

Medicare Part B Enrollment

Medicare Part B Enrollment

If you have been collecting Social Security Income (SSI) or Railroad Benefits (RRB) for at least 4 months before you turned 65, you will be automatically enrolled in Part B. Your Part B starts on the 1st day of your 65th Birthday month. Your Medicare ID Card should arrive in your mailbox as early as 3 months before you turn 65 years old!

If you have not been collecting SSI or RRB benefits for at least 4 months before you turned 65, you will have to manually apply to enrolled in Part B. You can enroll in Part A and/or B manually by calling or visiting your local Social Security Office. You can also file online at www.ssi.gov. We can help with all these at no charge to you as well.

Medicare Part B Cost-Sharing

Medicare Part B Cost-Sharing

Anyone who is enrolled in both parts of Original Medicare (Parts A and B) is eligible for Medicare Part C. Prior to 2021, there was a single condition that prevented beneficiaries from enrolling in Medicare Advantage plans and that was if they have a medical condition called End Stage Renal Disease (ESRD) or kidney failure. The requirements to enroll are really simple and they are as follows:

Deductible

The annual Part B deductible ($226 in 2023). You must meet this deductibe first before you start paying percentage for your medical services.

80/20 Coinsurance

After meeting your deductible, Medicare srtat paying 80% of your Part B medical services and you pay 20% of the remaining costs. It is important to note that there is no cap on Part B Coinsurance.

Excess Charges

You will be responsible to pay for any excess charges that a provider or a facility may charge beyond what Medicare reimburses.


As you can note that Part B 20% cost-sharing has no cap (no maximum limit) meaning that you continue to pay for medical service you use. It is very important to consider that some services like surgeries and chemotherapy are so expensive and medical expenses can be a huge financial burden. We strongly recommend meeting with a Medicare Advisor to discuss either Medicare Supplement (Medigap) Plans or Part C Medicare Advantage Plans to place a a maximum limit on your cost sharing.

Frequently Asked Questions (FAQs)

If you failed to sign up for Medicare when you were first eligible, and you didn’t have any Creditable Coverage, you will be subject to the Medicare Part B late enrollment penalty. This penalty is equal to 10% per year for every year (12 full months) that you waited to enroll. This penalty gets applied against the standard Part B premium, which in 2022 will be $170.10. Usually, you don't have to pay a penalty if you meet certain conditions that allow you to sign up for Part A during a Special Enrollment Period (SEP).

You’ll need to wait for the General Enrollment Period (GEP) to sign up for Part B. This period runs from January 1st to March 31st each year. Your benefits will then begin the following July. This can be a double whammy because not only do you now owe a penalty, but you have to wait several months for your coverage to kick in.

The best way to avoid the Medicare Part B Late Enrollment Penalty is to enroll in Medicare during your Initial Enrollment Period (IEP).

If you or your spouse have an employer Creditable Coverage, you may delay Medicare Part B past 65. Most people delay Medicare Part B because it has a monthly premium.

If you enrolled late because you’ve had employer group health coverage from a company with 20 or more enrollees, you will not be subject to the Part B Late Enrollment Penalty. 

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