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what is medicare part b

What is Medicare Part B and What Does it Cover?

What is Medicare Part B?

Medicare Part B (medical insurance) is part of Original Medicare. Original Medicare is comprised of Medicare Part A and Medicare Part B. It’s a federal health insurance program designed to provide and reduce the cost of health care services in the United States. If you are eligible for Medicare Part A, then you can also enroll in Medicare Part B.

Am I Eligible for Medicare Part B?

You are eligible for Original Medicare, including Medicare Part B, if you meet one of three criteria:

  • You’re aged 65 or older.
  • You’re younger than 65 with eligible disabilities by the Social Security Administration.
  • You have Amyotrophic Lateral Sclerosis (ALS) or End-Stage Renal Disease (ESRD).

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What Does Medicare Part B Cover?

Medicare Part B covers preventative services and medically necessary services. This includes care to prevent an illness or detect it at an early stage – and services or supplies needed to diagnose or treat a medical condition.

Part B Medicare covers, but is not limited to:

  • Orthopedic, Cardiology, Radiology, and other specialists
  • Mental health services (inpatient, outpatient, and partial hospitalization)
  • Screenings for common medical conditions
  • Preventative care, including annual wellness checkups
  • Vaccinations (flu, pneumococcal, Hepatitis B, and more)
  • Clinical research
  • Ambulance services
  • Durable Medical Equipment (DME)
  • Limited outpatient prescription drugs

There are many tests, items, and services that are not covered by Medicare Part B. These include routine dental, vision, and hearing care – such as check-ups, eyeglasses or contact lenses, hearing aids, dental extractions, and dentures.

We recommend that you ask your provider if your medical service or procedure will be covered by your Medicare plan. Learn more about whether a test, item, or service is covered.

When to Apply for Medicare Part B

Know your Initial Enrollment Period

You are first eligible for Medicare during your Initial Enrollment Period. For most, the Initial Enrollment Period begins three months before your 65th birthday, the month you turn 65, and ends three months after your 65th birthday. You have this seven-month window to enroll in Medicare.

Medicare eligibility quiz

Should you miss your Initial Enrollment Period, you can enroll in Medicare Part B during the General Enrollment Period (January 1 – March 31), or a Special Enrollment Period, if you qualify.

Instances when you’re automatically enrolled in Original Medicare

  • When you’re already receiving Social Security benefits, you’ll be automatically enrolled in Medicare Parts A & B starting the first day of the month you turn 65.
  • If you are younger than 65 with an eligible disability by the Social Security Administration, the Initial Enrollment Period does not apply to you. You will automatically receive Medicare Parts A & B after receiving disability benefits from the Social Security Administration for 24 months.
  • Have Amyotrophic Lateral Sclerosis or End-Stage Renal Disease? You’ll automatically get Medicare Part A and Part B the month your disability benefits begin.

Can I Delay Enrolling in Medicare Part B?

You can turn down or delay Medicare Part B enrollment. If you decide to enroll later on, your coverage could be delayed. And if you don’t have creditable coverage during that time, you may pay a late enrollment penalty.

Agent tip:

“If you decline Part B and don’t have creditable coverage, you could pay a late enrollment penalty that lasts as long as you have Medicare Part B.“

This penalty will be added to your Part B premium as long as you have Medicare Part B. The penalty could cause your premium to increase up to 10 percent for each year you were eligible for Part B and chose not to sign up – unless you qualify for a Special Enrollment Period.

Want to be sure that it’s the right time to enroll in Medicare Part B? Speak to a local licensed Medicare agent who can help you make the best decision for your health and finances. Call (623) 223-8884.

Not Yet Retired?

Suppose you are not retired and receive benefits from the Social Security Administration or Railroad Retirement Board at least four months before turning 65. You’ll need to sign up with the Social Security Administration to get Medicare Part A.

If you have private health insurance through your or your spouse’s employer, you can choose to delay Medicare Part B until you retire and receive Social Security benefits.

Considerations for delaying signing up for Medicare Part B:
  • Most people pay a Medicare Part B premium. Determine whether it’s more cost-effective to be on Medicare Part B on your or your spouse’s private health insurance coverage.
  • Your employer-based health insurance company may offer similar coverage to Part B medical insurance.
  • You should check with your group health insurance plan administrator about how your health plan works with Medicare coverage – see what happens once you’re Medicare eligible.

End-Stage Renal Disease

You can enroll in Parts A & B if you’re eligible for Medicare because of End-Stage Renal Disease. You can choose whether or not to sign up for Part B. However, you’ll need Parts A & B to cover certain services under Medicare, including dialysis and kidney transplant services.

Read more about End-Stage Renal Disease and Medicare to make an informed decision.

How to Sign up for Medicare Part B

Here are the four ways to apply for Original Medicare (Medicare Parts A & B) through the Social Security Administration. Already enrolled in Medicare Part A? Skip to the next section.

Choose the most convenient method for you:

  1. Apply online at Social Security Medicare Benefits.
  2. Visit your local Social Security office. Find your field office.
  3. Call Social Security at 1-800-772-1213 (TTY: 1-800-325-0778). Representatives are available Monday through Friday, from 8:00 AM to 7:00 PM in all U.S. time zones.
  4. If you worked for a railroad, call the Railroad Retirement Board at 1-877-772-5772.
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Already Enrolled in Medicare Part A?

Already enrolled in Medicare Part A, but previously declined Medicare Part B? You can enroll during your Initial Enrollment Period, General Enrollment Period, or a Special Enrollment Period. The timing depends on why you initially declined to enroll in Medicare Part B.

Read How to Apply for Medicare Part B if you previously declined Medicare Part B during your Initial Enrollment Period.

Last updated: October 18, 2022

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Read more by David Luna

I am a Spanish-speaking Arizona Life and Health Insurance Licensed Agent and have been helping people with Medicare since 2005. I am a Marine Corps Veteran & former police officer. I enjoy watching football and basketball but hold family time in the highest regard.

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