Original Medicare has two parts: Part A covers inpatient hospital costs, and Part B covers outpatient medical care, preventive care, durable medical equipment and more.
Medicare Part B is optional. Whether or not you need Part B depends on your individual situation.
You need to be aware that once you become eligible for Part B (generally when you turn 65), you will incur a late enrollment penalty for not signing up for Part B and decide you want it later, unless you meet one of the exceptions to the enrollment requirement.
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Another way to put the question is this: when don’t you need Part B?
Two situations in which you might not rely on Medicare Part B coverage include:
If you do not have “creditable coverage” after you first become eligible for Medicare Part B, you incur a penalty that you will pay when you eventually do enroll in Part B.
The late enrollment penalty fee amount is a 10 percent increase in your Part B premium (which is $170.10 per month for most people in 2022) for each 12-month period you could have enrolled in Part B but did not.
If you qualify for a Medicare Special Enrollment Period, you may not be required to pay the late enrollment penalty.
Once you’re eligible for Part B, you’re eligible.
If one of the exceptions applies that qualifies you for a Special Enrollment Period, you can drop other coverage and enroll in Part B at any time, assuming you have enrolled for Part A.
You may be automatically enrolled in Medicare Part A.
Your retiree health plan (if you have one) may require you to enroll in Medicare. Whether or not this is the case, many health plans coordinate benefits with Medicare.
Medicare is the usually the primary payer. You may find that adding part B coverage can help lower your overall out-of-pocket health care expenses. In any case, having other coverage doesn’t typically block you from enrolling in Part B if you are eligible.
You should consult your human resources office or benefits administrator to see how your employee or retiree plan coordinates with Medicare.
Yes, you can enroll in a Medicare Advantage plan during certain enrollment periods.
You should note that Medicare Advantage plans require you to be enrolled in Part B.
You may need to pay the Part B premium in addition to the Medicare Advantage plan premium, though some Medicare Advantage plans feature $0 premiums.
You may be able to switch from a Medicare Advantage plan to Original Medicare during any of the enrollment periods listed above.
Short answer: No, Part B doesn’t typically cover prescription drugs.
Longer answer: Part B may cover some drugs in a specific situations, typically only those that are administered by a doctor in their offices or in a clinic.
To get Medicare coverage for most retail prescription drugs, you need a Medicare Part D prescription drug plan or a Medicare Advantage plan that includes prescription drug coverage.
If you have Medicare Part A and Part B, you might also consider a Medicare Supplement Insurance (also called Medigap) plan.
Medigap plans can help cover some of the out-of-pocket costs that Medicare does not cover, such as deductibles, coinsurance and copayments.
Remember that Original Medicare does not have an out-of-pocket spending limit. This means that in the case of a serious illness, Medicare copayments and deductibles can add up quickly.
Call to speak with a licensed insurance agent who can help answer your Medicare questions and help you compare Medicare Advantage plans in your area if you’re eligible to enroll.
You may be able to find a plan that provides Part B benefits as well as some additional benefits that may fit your coverage needs.
Speak with a licensed insurance agent
Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.
Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.
Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.
Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.
A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.
If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.