What is Medicare Part B? A Baby Boomer’s Guide

medicare part b coverage

Medicare Part B is the part of Medicare that covers doctor’s appointments and outpatient services.

Medicare Part B is essentially medical insurance that covers expenses unrelated to the hospital such as blood tests, doctor’s visits, outpatient hospital care, X-rays, and diabetic supplies. The good news about Medicare B is that it typically pays for the majority of lab tests and medical services your physician orders.

When enrolling in Medicare, most people choose to sign up for both Parts A and B. Although Part A does not require a monthly premium to be paid, Part B does. The premium as of today is $148.50 per month.

Note: Medicare and Medicaid are often confused. You can learn about Medicaid here. Or learn the differences between Medicare and Medicaid here.

What Does Medicare B Cover?

As the perfect complement to the hospital coverage that defines Medicare Part A, Part B covers outpatient services.

Below are some of the services covered by Part B.

  • Chemotherapy
  • Kidney dialysis
  • Emergency ambulance services
  • Occupational therapy
  • Emergency room care
  • Lab tests
  • Outpatient hospital care
  • Mental health services
  • Diabetes screenings
  • Bone density measurements
  • Testing for sexually transmitted infection
  • Hepatitis and HIV screenings
  • Cardiovascular tests
  • Blood work
  • Colorectal cancer testing
  • Glaucoma tests
  • EKG screening
  • Diabetes care training
  • Telehealth
  • Pulmonary rehabilitation
  • Prostate cancer testing
  • Physical therapy
  • Limited prescription drugs
  • Occupational therapy
  • Pap tests
  • Pelvic exams
  • Mammograms
  • Surgical dressing services
  • Transplants and immunosuppressive drugs
  • Kidney dialysis services and supplies
  • Prosthetic/Orthotic items
  • Durable medical equipment
  • Home health services
  • Hearing and balance exams
  • Kidney disease education services
  • Flu shots
Who Qualifies for Medicare Part B?

As part of original Medicare, Part B should be signed up for with Part A, within the seven-month enrollment period around a senior’s 65th birthday. It is important to sign up for Medicare Part B on time or risk paying penalties that can be included in your monthly payment. Unfortunately, this is not a one-time fee.

How do You Sign up For Medicare Part B?

One of the reasons enrollment into Medicare can be confusing is because certain groups of people are automatically enrolled in Medicare. For example, individuals already taking social security benefits, or who are qualified by the Railroad Retirement Board, or who suffer from certain disabilities are automatically enrolled in Part A. Additionally, U.S. citizens suffering from amyotrophic lateral sclerosis(ALS) are also automatically enrolled.

Baby boomers reaching the age of 65 who aren’t automatically signed up must sign up on their own through the SSA office. Three months before turning 65 years of age, seniors can sign up for Medicare Part A and B. The initial enrollment period begins three months prior to their 65th birthday and for the three months following the birthday month. To avoid the chance of a penalty, seniors can sign up during this seven-month enrollment period with no worries.

The open enrollment lasts from October 15th through December 7th. This period is important because it allows seniors to change from enrollment into original Medicare that includes Part A and B to Medicare Part C or Medicare Advantage which is preferable for some boomers. This period can also be used for substituting new Part C plans or adding or removing a Part D plan.

The general enrollment period is from January 1st through March 31. For those who don’t enroll in Medicare during the initial enrollment period, they can enroll during the special enrollment period with an approved reason. That means you have eight months from the end of your coverage as an employee to sign up for Medicare without incurring a penalty.

It is highly recommended that seniors sign up for Medicare B on time. The penalty charged for people who are late signing up is 10%. While that might not seem like a big deal on the surface, when you consider the fact that you will continue paying that 10% fee for as long as you are covered under Medicare, then it becomes clear that you are paying a large and avoidable fee for signing up late.

What Does Medicare B Cost?

The standard monthly premium for most enrollees is $148.50 as of 2021 rates. Rates are higher for couples making over $176,000 or singles earning over $88,000.

Like most commercial insurance policies, Medicare also charges an annual deductible. The 2021 annual deductible is $203. Additionally, baby boomers will also be charged a 20% coinsurance fee for services covered.

What is Not Covered by Medicare Part B?

While the long list of Part B services covered is fairly lengthy, it is important that you understand that the coverage is not all-inclusive. In fact, there are services that your physician might suggest that won’t be covered by Medicare Part A or B.

Below is a list of services that Medicare B does not cover.

  • Long-term care
  • Dental care in most cases
  • Eye exams for glasses
  • Cosmetic surgery
  • Foot care
  • Hearing aids

Takeaway

Medicare Part B covers very important healthcare costs related to outpatient services and tests that can add up to a large sum of money that would be difficult to pay for most people on a fixed income.

While many seniors are automatically enrolled in Medicare Part A, Medicare Part B is not automatic coverage. With that said, it is crucial to sign up for this important coverage on time or risk paying a 10% penalty that is charged monthly as long as the coverage lasts.

Belinda Tucker
A Baby Boomer herself, Belinda has a passion for investigating topics that are important to aging adults and then making any confusing concepts clear. Belinda's professional career included serving as a Corporate Recruiter, Mortgage Executive and Real Estate Salesperson. She writes for BoomerBuyerGuides.com on a variety of financial topics.