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Medicare Part B Coverage

You probably never thought about Medicare until you started to get close to age 65. (Don’t worry, no one does!)

In this handy dandy guide we have provided some information on enrolling in Medicare Part B.

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Sign Up Periods for Medicare Parts A and B

When you’re first eligible for Medicare, you have a 7-month Initial Enrollment Period (IEP) to sign up for Part A and/or Part B. If you’re going to be eligible for Medicare when you turn 65, your 7-month enrollment period:

  • Begins 3 months before the month you turn 65
  • Includes the month you turn 65
  • Ends 3 months after the month you turn 65

In most cases, if you don’t sign up for Medicare Part B when you’re first eligible, you’ll have to pay a Part B late enrollment penalty. You’ll have to pay this penalty for as long as you have Part B and you could experience a gap in your health coverage.  

Some people get Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) automatically and other people will have to sign up for it. In most cases, this will depend on whether you’re getting Social Security benefits. Individuals who have been receiving disability benefits from Social Security for 24 months and certain disability benefits from the Railroad Retirement Board for 24 months will receive Parts A and B automatically.  

Most people should enroll in Part A when they turn 65, but certain people may choose to delay Part B. The most common reason for delaying Part B is because you already have existing coverage through your employer. The size of the employer determines whether you may be able to delay signing up for Part A and Part B without having to pay a penalty at a later date. If your employer has fewer than 20 employees, you should sign up for Part A and Part B when you’re first eligible. Medicare will pay before your employer’s coverage in this case.  

If your employer has 20 or more employees, ask your benefits manager if you have creditable group health plan coverage (as defined by the IRS). Most health insurance coverage provided by employers is considered creditable coverage. People with group health coverage from their current employment may be able to delay Part A and Part B without a lifetime late enrollment penalty. If you want to delay both Part A and Part B coverage, you don’t need to do anything when you turn 65. 

How do I apply for coverage?

You can apply online for Medicare even if you are not ready to retire. It takes less than 10 minutes. There are no forms to sign and usually no documentation is required. Social Security will process your application and contact you if they need more information. To enroll now, follow the instructions on Medicare Benefits.

What does Medicare Part B Cover?

Medicare Part B covers your basic medical needs. In general, Medicare Part B covers 80% of services, including doctor visits, lab tests, and medical equipment. You can also use Medicare Part B to obtain second opinions about a medical issue. Part B provides coverage for orthopaedic, cardiology, radiology, and any other specialist from A to Z. Screenings for common medical conditions and a full annual wellness checkup are covered by Part B. Flu shots, pneumococcal shots, and hepatitis B shots are covered by Part B with no copay. 

Ask your provider if your medical services are covered by Medicare. It is possible that you may need something that Medicare usually covers, but that your provider thinks won’t be covered due to your situation. In this case you’ll have to read and sign a notice. This notice says that you may have to pay for the item, service, or supply. We recommend using this link to find out if Medicare covers your item, service, or supply.  

Can I terminate Medicare Part B?

You can voluntarily terminate your Medicare Part B (medical insurance). We recommend you have a personal interview with a Social Security representative. They will help you complete Form CMS 1763. To find out more about how to terminate Medicare Part B or to schedule a personal interview, contact Social Security at 1-800-772-1213 (TTY: 1-800-325-0778) between Monday through Friday from 8:00 AM to 5:30 PM. You can also contact your nearest Social Security office.

How much will I pay for Medicare Part B?

The standard Part B premium amount in 2022 is $170.10. Most people pay the standard Part B premium amount. If your modified adjusted gross income 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 (IRMAA). IRMAA is an extra charge added to your premium (see rates here).

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