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Medicare Part B Texas

Medicare Part B is one of the most important parts of Medicare because it provides the widest range of coverage for its beneficiaries. It is a part of the Original Medicare, whilst Part A stands for hospital insurance, Part B is medical insurance. It covers outpatient services. Part B also has a very specific enrollment period, so you want to be informed about it because you could face pretty big penalties due to late enrollment if you don’t know how this operates.

Part B Coverage Texas

As already established, Part B is the other half of the Original Medicare. It is medical coverage and covers outpatient services, doctor visits, ambulance transportation, durable medical equipment, preventive care, mental health services, and many non-self-administered medications. Basically, Part B will cover any medically necessary service. 

Therefore, Medicare beneficiaries will be covered for:

  • physical exams once a year
  • office visits 
  • laboratory tests: x-rays and blood work, MRIs, CT scans, EKG and some other diagnostic tests
  • durable medical equipment: hospital beds, wheelchairs, walkers, scooters, nebulizers, blood sugar tests, etc. 
  • orthotics and prosthetics
  • ambulance services
  • mental services: outpatient care and partial hospitalization if  you meet the requirements 
  • preventive care: for example, flu shots
  • part-time skilled nursing facility and health aide for homebound 

However, Medicare Part B doesn’t provide coverage for:

  • long term care: there is no nursing home care that is longer than a hundred days
  • hearing and dental services: doesn’t provide hearing aids nor any dental care
  • foot care
  • cosmetic surgery
  • acupuncture etc.
  • prescription drug coverage (it is covered under Medicare Part D)
  • care outside the U.S. 

Medicare Part B Costs 

Part A is free for most Medicare beneficiaries, but Part B isn’t. Most Medicare enrollees have to pay a standard monthly premium to stay enrolled in Medicare. Part B’s monthly premium in 2022 is 170.10$ but it will be 164.90$ in 2023.  Also, you can pay more for your monthly premium if you are a high-income earner. Medicare looks at your income from two years ago which determines how high will be your Medicare Part B premium, This is also called IRMAA or income-related adjusted amount.

Like in other parts of the country, Medicare Part B in Texas also has an annual deductible. In 2022, the cost per year is 233$ but in 2023, this cost will be 226$. It resets every new calendar year (January 1st) and it can be subject to change every year.

You first need to pay 233$ (226$ next year) before Medicare coverage kicks in. However, Original Medicare covers only 80% of the services, which means that beneficiaries are still responsible for the other 20% of the cost. Also, it is important to know that there is no cap on this 20% which means you will have to pay the full 20% of all medical charges without an out-of-pocket limit.

However, you can always cover this 20% by enrolling in some of the Medicare supplement plans (lettered A to N) which are designed to cover the gaps that Original Medicare has left. 

Enrolling In Part B Texas

The first question we need to determine before we explain how to enroll in Part B is whether should you enroll in it when you are first eligible. For some people, it will be good to enroll when first eligible, but for some, it is better to wait.

For example, if you are 65 and eligible for Medicare coverage, but still working and have group health coverage through your employer it is better to delay your Part B enrollment. However, this is only the case if your company has more than 20 employees because group health coverage is a primary source and Medicare is a secondary source of coverage in this case. So, you can delay the Part B enrollment penalty in this case you just need proof that you had creditable coverage before. But, if you still working at the age of 65 in a company that has less than 20 employees it is better to enroll in Part B since it is a primary source of coverage, and a health plan through the employer is secondary- it is unnecessary to have to types of coverage.

If you retired or don’t have health insurance through your employer, we advise you to enroll when first eligible because you will avoid a late enrollment penalty.

How To Apply For Medicare Part B In Texas 

If you don’t. meet the requirements to delay Part B enrollment, the best way to do so is during your Initial Enrollment Period (IEP). IEP is different for every Medicare beneficiary because it begins three months before you turn 65 and ends three months after you are 65 (including your birthday month). 

However, when your coverage will start depends on when you actually enroll. If you choose to enroll during the first 3 months, your coverage will usually begin the month you turn 65. If you enroll on your birthday month, or up to three months after your Part B effective date will most likely be delayed. 

Your Part B effective date will be as follows:

  • if you enroll 1 month after your 65th birthday: coverage will start 2 months after
  • if you enroll 2 months after your 65th birthday: coverage will start 3 months after
  • if you enroll 3 months after your 65th birthday: coverage will start 3 months after

Special Enrollment Period

If you are one of the people who are working at age of 65 and getting health insurance through your employer but now want to get Medicare coverage due to retirement, or other life events you can do it during the Special Enrollment Period.

You have up to eight months after you lose your active group health insurance coverage to enroll in Part B without a penalty. This doesn’t apply to COBRA. benefits.

You can apply by submitting CMS-40B (Part B enrollment) and CMS L-564 (employer) forms to Social Security. In the comment section you can write when you would like your Part B to begin, and the second form requires a signature from your employer stating that you had creditable health insurance coverage.

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