What Is Medicare Part B?

Original Medicare is comprised of two parts: Part A (hospital insurance) and Part B (outpatient insurance). Medicare Part B, also known as medical insurance, generally provides coverage for services such as outpatient care, home health care, durable medical equipment, lab tests, surgeries, and preventive treatments.

What Does Medicare Part B Cover?

Medicare Part B covers a broad range of medical services and supplies, including:

• Most doctor services (including most doctor services while you're a hospital inpatient)
• Outpatient surgery and therapy
• Doctor visits to diagnose a mental health condition
• Lab tests and X-rays
• Durable medical equipment like wheelchairs or walkers
• Physical therapy and rehabilitation services
• Home health care services, including nursing care and occupational therapy

Part B also helps cover a list of preventive services and certain prescription drugs, such as:

• Annual wellness check-ups
• Vaccinations for influenza, COVID-19, Hepatitis B, and pneumonia
• Cancer screenings
• Diabetes preventive screenings
• Mental health screenings for depression
• Mammography for breast cancer detection

How Much Does Part B Cost?

Medicare Part B premiums are usually a standard monthly price. For example, in 2024, most Medicare enrollees must pay a monthly Part B premium of $174.70. However, your Part B premium increases if your income exceeds a certain amount.

Your Part B premium is automatically deducted from your benefit payment if you receive benefits from one of these:

• Social Security
• Railroad Retirement Board
• Office of Personnel Management

Like most insurance plans, Medicare Part B has a standard deductible. For 2024, the deductible amount is $240. Once you have met your annual deductible, Medicare will cover 80% of the approved cost of the covered services listed above, and you will be responsible for paying the remaining 20% of the cost out-of-pocket.

Who Is Eligible?

‍To be eligible for Medicare in Florida, you must:

• Be 65 years of age or older.
• Be a legal resident of the U.S. AND
• Be either a U.S. citizen OR a legal alien who has resided in the U.S. for at least five consecutive years.

OR if you are under 65, you may be eligible if you have:

• End-stage renal disease (ESRD)
• ALS (also called Lou Gehrig's disease)
• Certain disabilities

To see eligibility specifics, click here.

When Should You Enroll in Medicare Part B?

The Initial Enrollment Period (IEP) is a seven-month enrollment period that begins three months before your 65th birthday, includes your birthday month, and ends three months after your 65th birthday. So, for example, if your birthday is in July, your IEP lasts from April to October. This is the best time to enroll because all applicants are guaranteed coverage no matter their health situation and cannot be charged more or denied.

If you miss the IEP, you can also apply for Part B during the Medicare General Enrollment Period (GEP), which lasts from January 1st to March 31st each year. However, enrolling anytime after your IEP may result in a late enrollment penalty, which could affect your monthly premium as long as you have Medicare.

If you're covered by an employer or union group health plan at any age, you can delay Part B enrollment without a late penalty. You'll have an eight-month window starting when your employer coverage or employment ends (whichever happens first) to sign up for Part B.

If you're eligible for both Medicare and Medicaid, you will be automatically enrolled in Part B when you turn 65 unless you refuse. You can opt out by completing a refusal form sent to you before your 65th birthday and sending it back.

Bottom Line

Medicare Part B is a crucial part of Medicare that provides coverage for medically necessary services, preventive care, and medical equipment. Enrolling in Part B during your Initial Enrollment Period is important to avoid penalties and gaps in coverage. However, you should also know the costs of Part B and the coverage limitations. If you have any questions or need help navigating Medicare and drug coverage, seek advice from a trusted healthcare expert or a Medicare advisor.

FAQs

What is the difference between Medicare Part A and Part B?

Medicare Part A primarily covers inpatient hospitalization, skilled nursing facility care, and mental health services, while Part B covers medically necessary services, preventive care, and medical equipment.

Can I delay enrolling in Medicare Part B if I have other health insurance?

Yes, you can delay enrolling in Part B if you have coverage through an employer or union group health plan. However, you'll have a specific eight-month enrollment window once your coverage or employment ends.

What is the late enrollment penalty for Medicare Part B?  

If you don't sign up for Medicare Part B when you're first eligible, you might have to pay a late enrollment penalty for as long as you have Medicare coverage. This penalty can increase your monthly premium by 10% for each 12-month period you were eligible for Part B but didn't sign up.

Does Medicare Part B cover emergency room visits?  

Yes, Medicare Part B covers emergency room visits and helps pay for emergency or critical care services in an emergency department. After you've met your Part B deductible, you typically pay 20% of the Medicare-approved amount for the doctor or other healthcare provider's services.

Are prescription drugs covered under Medicare Part B?  

Medicare Part B covers a limited number of outpatient prescription drugs, primarily those you wouldn't typically administer to yourself, like intravenous medications or medicines given through a nebulizer. Part D is available for more comprehensive prescription drug coverage.

Florida Medicare Resources

Medicare.gov - The official U.S. government site for Medicare, where one can find information about coverage options and compare plans in Florida.

Florida Department of Elder Affairs - Provides resources and assistance for seniors in Florida, including long-term care options and financial assistance programs.

Florida SHINE Program - A volunteer-based program that provides free, unbiased health insurance counseling for Florida Medicare beneficiaries.

MyBenefitsFlorida - A website that provides information and resources for Florida residents on Medicare Advantage and prescription drug plans.