Medicare Plans by Turning 65 Solutions


Medicare Part B

Medicare Part B is a medical insurance coverage that provides services related to outpatient and preventive care. In general, it will cover doctor visits, diagnostic tests to prevent illness, skilled nursing, and all services that are considered medically necessary.

Medicare Part B Coverage

Therefore, beneficiaries will get covered under Part B for:

  • Outpatient care 
  • Doctor-ordered x-rays and lab tests
  • Doctor visits 
  • Provider services that are considered medically necessary
  • Home health services like skilled nursing facilities  or therapy care:  long-term care isn’t covered (more than 100 days)
  • Durable medical equipment that is appropriate for home use like walkers, wheelchairs, etc. 
  • Ambulance services: emergency transportation by ambulance 
  • Preventive services, like outpatient physical, speech, and occupational therapy
  • Some prescription drugs, such as immunosuppressants and select anti-cancer drugs
  • Annual physical exams 

Medicare Part B doesn’t provide coverage for long-term care, services that aren’t considered medically necessary such as cosmetic surgeries and routine foot care,  hearing aids, dental and vision services, etc. Care outside the United States is also not provided. 

Medicare Part B Costs

Although most people qualify for the Part A free premium, the Part B monthly premium is obligatory for every Medicare beneficiary. The monthly premium cost is 164.90$ in 2023. To start your Part B coverage, beneficiaries are also responsible for Part B’s annual deductible. A deductible is 226$ in 2023, and once you’ve met your deductible Medicare Part B starts to pay for covered services. However, Original Medicare only pays 80% so you will still be responsible for paying the remaining costs. This is commonly called copay or coinsurance. If you don’t have a Medicare Supplement plan, as part of your coverage, which might help beneficiaries cover costs left by Original Medicare, you will typically pay 20% of coinsurance for provided service.

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Applying for Medicare Part B

You will automatically be enrolled if you have already started receiving Social Security benefits. You will get a card in the main by the month before your  65th birthday.

However, if you do not receive Social Security benefits, you must enroll yourself in Medicare Part B. The best time to enroll in Medicare Part B is during the Initial Enrollment Period. IEP is different for every Medicare beneficiary because it is a 7-month open enrollment window that starts three months before you turn 65 and ends 3 months after your 65th birthday. If you miss your IEP and hadn’t creditable coverage before, you will pay a late enrollment penalty for Part B which means your monthly premium will be higher as long as you have your Medicare coverage.

However, if you had creditable coverage, like your group health insurance plan because you have worked past 65, you may not be a subject to late enrollment penalty. This is only the case if you work in a company that has more than 20 employees because group health insurance comes first. You have 8 months to apply for Part B after you retire. But, if you work in a company that has less than 20 employees and are eligible for Medicare coverage, enroll in Part B during your IEP because in that case, Medicare coverage comes first, so you could avoid late enrollment penalty charges.


Medicare Part B Excess Charges

Medicare Part B Excess Charges are not that common but may happen if you go to a doctor or a hospital which don’t accept Medicare Assignment. There is a small list of doctors and hospitals which don’t accept Medicare’s payment as payment in full. In that case, doctors or hospitals may bill you up to 15% above the Medicare-approved amount for provided service. This means that if you have only Original Medicare and go to seek service. from doctor and hospital that doesn’t accept Medicare Assignment, you will have to pay 20% of coinsurance and add 15% to that 20% of regular coinsurance costs. Some Medicare Supplement plans, like G and F, cover Part B Excess charges cost.

However, if you don’t have a Medicare Supplement plan that covers Part B Excess charges, you can easily avoid them if you check on the official government site which doctors and hospitals do accept Medicare Assignment as payment in full.  Also, some states like Vermont, New York, Massachusetts, Minnesota, Rhode Island, Connecticut, Pennsylvania, and Ohio forbid Part B Excess charges.

Get Medicare Help in Texas

If you or someone you know is new to Medicare, consult an experienced agent. Ron Ray works hard to help his clients find the best coverage for both their budget and healthcare needs. Give Ron a call today at 830-217-6711  His office is located in New Braunfels, Texas.