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Outpatient service from Medicare Part B

Do you need Medicare Part B?

Medicare Part A is highly advisable because it covers hospital care. If you get premium-free Part A, you do not have to buy Part B. If you have to buy Part A, it must be purchased with Part B.

Medicare Part B is medical insurance. While you can opt-out of Part B if you have premium-free Part A, you should consider the implications of doing so.

What is Medicare Part B?

Medicare Part B (Medical Insurance) is offered through Original Medicare and covers annual wellness visits, laboratory tests, bloodwork, x-rays, medical equipment, mental healthcare, and ambulance services. It is the other half of Original Medicare. Under its insurance, in most cases you will pay 20% of the Medicare-approved amount for each item or service. It does not cover DHV (dental, hearing and vision) exams, hearing aids or glasses, emergency assistance outside U.S., long-term care and Prescription drug coverage. Medicare Part B requires you to pay a monthly premium, given based on your adjusted gross income together with a yearly deductible before coverage begins. The standard monthly fee for Part B is $170.10 in 2022. It is higher for recipients who have higher incomes. The annual deductible for Part B is $233 in 2022.

Part B Eligibility

For Medicare Part B eligibility applies the same rules as for Medicare Part A. Primary criteria is that you must be age 65 or older and a U.S. citizen. Legal and permanent residents of the United States for at least 5 years in a row can also qualify for Part B. Finally, you can apply for it if you have been diagnosed with End-stage renal disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS). Person under the age of 65 with certain disabilities that harden normal life and requires high care and attention can apply as well.

Blood transfusion covered in Medicare Part B

What If I Delay Enrollment?

All persons entitled to Medicare Part A are also entitled to enroll in Part B. An aged person not entitled to Part A may enroll in Part B if he/she is aged 65 or over and either a U.S. citizen or lawfully admitted for permanent residence who has resided in the United States continuously for 5 years in a row. Person who is automatically enrolled in Medicare Part A is also automatically enrolled in Part B. However, because beneficiaries must pay a premium for Part B coverage, they have the option of turning it down. Those who choose to receive coverage through a Medicare Advantage plan – Part C must enroll in Part B.

If you have health insurance through your employer of more than 20 people, you qualify for a special enrollment period. This special enrollment period allows you to enroll once you lose the coverage or are no longer employed. If you enroll during the eight months of your special enrollment period, you do not have to pay a late enrollment penalty.

Other examples of delayed enrollment include:

  • If you have retiree or COBRA coverage, you are advised to enroll in Part A and B at the same time during initial enrollment.
  • If you have TRICARE and are retired, enroll in Part B to continue coverage. If you are active duty, enroll in Part B before retiring to avoid a break in coverage.
  • If you have Veteran’s benefits, enroll in both Parts A and B when you are eligible.
  • If you have CHAMPVA, enroll in Part B to keep your coverage.
  • If you have End-Stage Renal Disease (ESRD), you should enroll in Part B (without a late penalty) to receive Medicare’s full benefits for your condition.
  • If you have another private insurance, drop it and enroll in Parts A and B when you turn 65.
  • If you don’t have coverage, enroll in Part B when first eligible.

Late Enrollment Fees

Part B’s late enrollment penalty adds 10% of the standard premium rate for each 12-month period you went without signing up. This lasts as long as you hold Part B coverage. The standard premium rate in 2022 is $170.10.

For all of your Medicare questions, speak with Turning 65 Solutions.

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