Original Medicare is made up of two parts: Medicare Part A and Medicare Part B.
Medicare Part B is also known as medical insurance and helps cover medical services and supplies that help treat health conditions or prevent disease.
What does Medicare Part B cover?
Some examples of the types of services covered under Medicare Part B include:
- Yearly wellness exams and preventive services
- Doctor services
- Ambulance services
- Durable medical equipment
- Mental health services
How much does Medicare Part B cost?
Medicare Part B requires you to pay a monthly premium for your Part B benefits. In 2021, the standard Part B premium is $148.50 per month.
Some beneficiaries may pay more than the standard Part B premium because they have a higher income. This extra amount is called the Income-Related Monthly Adjustment Amount (IRMAA).
The highest income earners will pay $504.90 per month for their Part B coverage in 2021, based on the Medicare IRMAA.
Medicare Part B also has some out-of-pocket costs that you must pay, including:
- Part B deductible
In 2021, the Medicare Part B deductible is $203 per year.
This represents the amount of money you must pay out of your own pocket for covered services and items before your Part B coverage kicks in for the rest of the year.
- Part B coinsurance
Once your Part B deductible is met, you pay 20 percent of the Medicare-approved amount for covered services. The Medicare-approved amount is the amount that Medicare has determined it will reimburse for each service or item it covers.
This 20 percent cost is known as the Medicare Part B coinsurance.
- Medicare Part B excess charges
Some health care providers do not accept Medicare reimbursement as full payment for their services.
These providers reserve the right to charge up to 15 percent more than the Medicare-approved amount for their services or items, which is known as an “excess charge.”
- Part B late enrollment penalty
When you first become eligible for Medicare, you’ll be given an Initial Enrollment Period (IEP) during which you can sign up for Medicare Part A and B (if you're not automatically enrolled).
If you choose not to enroll in Medicare Part B during this time, you may face a late enrollment penalty if you decide to sign up at a later time.
The late enrollment penalty is equal to 10 percent of the standard Part B premium for each full 12-month period that you were eligible for Part B but did not have it.
You’ll have to continue paying this penalty for as long as you continue to have Part B.
Medicare Part B is optional. Many beneficiaries are automatically enrolled. If you aren't automatically enrolled, you may need to sign up during one of the Medicare enrollment periods.
Medigap plans can help cover Part B out-of-pocket costs
Medicare Supplement Insurance, also called Medigap, helps cover some of the out-of-pocket expenses associated with Part A and Part B.
Some Medigap plans can cover the cost of the Part B deductible, Part B coinsurance and excess charges.
What does Medicare Part B not cover?
Medicare Part B does not cover hospital or skilled nursing facility costs. Your Medicare Part A benefits cover these types of services.
Neither Medicare Part A or Medicare Part B cover:
- Prescription drugs
You can get Medicare prescription drug coverage in one of two ways. You can either enroll in a standalone Medicare prescription drug plan (Medicare Part D), or you can join a Medicare Advantage plan (Medicare Part C) that offers prescription drug coverage.
- Dental care
Medicare Part B doesn’t cover routine dental care, such as teeth cleanings, dental X-rays or other services. Some Medicare Advantage plans offer coverage for dental care.
- Vision care
Medicare Part B does not cover routine vision care, glasses or contact lenses. Some Medicare Advantage plans offer vision benefits.
- Hearing services or hearing aids
Medicare Part B does not cover routine hearing care, hearing aids or the maintenance costs that can come with having hearing aids. Some Medicare Advantage plans may offer hearing benefits.
Not all Medicare Advantage plans offer these benefits. Plan availability can vary based on where you live.
Medicare Advantage plans can cover medical insurance and additional benefits
Medicare Advantage is an alternative to Original Medicare that is sold by private insurance companies. Every Medicare Advantage plan provides at least the same benefits as Medicare Part A and Medicare Part B combined in one plan.
If you are interested in finding a plan that may offer more coverage than Medicare Part B and Part A, you can call to speak with a licensed insurance agent to find Medicare Advantage plans that may be available in your area.
Or call TTY Users: 711 to speak with a licensed insurance agent. We accept calls 24/7!