Are you approaching Medicare eligibility? Whether you’re on the verge of turning 65 or you qualify for Medicare due to other health circumstances, it’s important to understand what Medicare Part B coverage entails.
At Benafica, we work with individuals and companies to determine the best health coverage options to meet their unique needs. If you’re planning on enrolling in Medicare Part A, then it’s likely you’ll also enroll in Part B, and this blog, we explain what you need to know about Part B enrollment, coverage, and costs.
What Does Medicare Part B Cover?
Medicare Part B is also referred to as medical insurance. It provides coverage for medically necessary services, such as outpatient care, physicians’ services, a variety of preventive services, and other health care services (including certain types of in-hospital care) that Medicare Part A does not cover.
Coverage includes but is not limited to:
Lab testing and diagnostic imaging
Home health care
Certain cancer treatments
Certain types of medical equipment
Medications administered in a clinical setting
It’s important to note that having Medicare Part B is optional. Because you must pay a premium for Part B coverage, you can turn it down. However, if Medicare is your primary form of health coverage, enrolling in Part B is highly recommended.
Plus, if you choose not to enroll in Part B when you become eligible for Medicare and then decide you want it later, your coverage could be delayed, and you may have to pay a higher monthly premium for as long as you have Part B.
Furthermore, you cannot qualify for Medigap supplemental coverage if you don’t have Part B.
Who Is Eligible for Medicare Part B Coverage?
Any individual who is eligible to enroll in premium-free Medicare Part A can get Medicare Part B by enrolling in Part B coverage and paying a monthly premium. If you don’t qualify for premium-free Part A, you can still get Part B coverage if you meet the following requirements:
You are 65 years of age or older.
You are a U.S. citizen or a permanent resident and have lawfully resided in the United States for a minimum of five continuous years.
If you are under the age of 65 and you receive disability benefits through Social Security or the Railroad Retirement Board, your Medicare Part B enrollment will occur automatically. However, you must receive those disability benefits for 24 months before your automatic enrollment takes place.
When Is the Best Time to Enroll in Medicare Part B?
The best time to sign up for Medicare Part B is during the 7-month Initial Enrollment Period (IEP) surrounding your 65th birthday. It’s important to enroll in Part B when you first become Medicare eligible because enrolling outside of your IEP carries a penalty, which you’ll continue to pay as long as you have Part B.
If you know you’ll be eligible for Medicare when you turn 65, you should enroll in the program within one of the following time periods:
During the 3-month period preceding the month of your 65th birthday
During the month of your 65th birthday
During the 3-month period after the month of your 65th birthday
Though your 7-month Initial Enrollment Period is the best time to sign up for Part B coverage, that’s not the only period during which you can enroll. You can also sign up during the General Enrollment Period (GEP), which occurs between January 1 and March 31 of each year. However, you must meet the following conditions to sign up during the GEP:
You did not sign up when you first became eligible
You are not eligible for a Special Enrollment Period (SEP)
For a full breakdown of Medicare Part A and Part B enrollment periods, including the conditions you must meet to qualify for an SEP, refer to the comprehensive overview at Medicare.gov.
What Costs Are Associated With Medicare Part B?
While most people who are 65 years of age or older can get premium-free Medicare Part A, that’s not the case with Part B. Most individuals pay a monthly premium for Part B coverage, and if you miss your initial enrollment period, you’ll pay a monthly penalty too.
However, if you’re still working, you have coverage under your employer’s group health plan, and you choose not to sign up for Part B during your initial enrollment period, that penalty may not apply.
When you elect to delay Part B coverage because you already have employer-sponsored coverage, you can enroll in Part B later during a Special Enrollment Period. Your SEP begins when your employer coverage ends or your employment ends, whichever occurs first. You have eight months from that date to enroll in Medicare Part B without paying a late penalty.
If you’re curious about specific Part B premium costs, it’s best to speak with a licensed insurance advisor. Because premiums depend on your modified adjusted gross income and can change from year to year, consulting an advisor will ensure you receive accurate, up-to-date information.
Confused About Medicare? Discuss Your Coverage Options With Benafica
If you need expert guidance on your health coverage options, including enrolling in a Medicare plan, get in touch with our team at Benafica. Our licensed advisors are seasoned experts in the insurance industry and can help you find the best health plan to meet your unique needs.
To learn more about how we can help you, feel free to schedule a complimentary consultation or call our St. Paul office today at 651-287-3253 . You can also get in touch with us via our contact form, and a representative will reach out to you promptly.