Do I Need Medicare Part B? Answers From Medicare Expert Charles MacKay

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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Should I get Medicare Part B?

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:

  • A Medicare Advantage (Medicare Part C) plan is an alternative to Part A and Part B (though you still need to enroll in Part B before you can enroll in a Medicare Advantage plan).

    Your Medicare Advantage plan carrier (a private insurance company) provides all of your Part A and Part B benefits, instead of the federal government. Many Medicare Advantage plans may provide additional benefits Original Medicare doesn’t cover, such as prescription drug coverage.

  • You may have “creditable coverage” that Medicare regards as equivalent to Part B.

    Situations in which you have creditable coverage include:

What the Part B late enrollment penalty?

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 $135.50 per month for most people in 2019) for each 12-month period you could have enrolled in Part B but did not.

  • For example, if you did not enroll in Part B when first eligible and delayed your enrollment for 14 months (and if no enrollment exception applied), your standard Part B premium amount – including your late enrollment penalty – would be $149.05 per month.

  • This total includes the standard Part B premium of $135.50 per month, plus your late enrollment penalty of $13.55 per month (10 percent of $135.50).

If you qualify for a Medicare Special Enrollment Period, you may not be required to pay the late enrollment penalty.

Can I drop other coverage to enroll in Part B?

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.

Can I switch from Part B to a Medicare Advantage plan?

Yes, you can enroll in a Medicare Advantage plan during certain enrollment periods.

  • Initial Enrollment Period (IEP)
    Your Initial Enrollment Period starts 3 months before your turn 65, includes your birth month and continues for another 3 months after that.

    During this 7-month period, you can enroll in Original Medicare and a Medicare Advantage plan.

  • Annual Enrollment Period (AEP, also called the Annual Election Period)
    This enrollment period (also called the Open Enrollment Period for Medicare Advantage & Medicare prescription drug coverage) lasts from October 15 to December 7 every year.

    During Medicare AEP, you can enroll in a Medicare Advantage plan or switch from one Medicare Advantage plan to another.

  • Special Enrollment Period (SEP)
    As mentioned above, you could potentially qualify for a Special Enrollment Period for a number of reasons. Depending on your situation, you may be able to enroll in a Medicare Advantage plan during a Medicare SEP.

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.

Can I switch from a Medicare Advantage plan to Part B?

You may be able to switch from a Medicare Advantage plan to Original Medicare during any of the enrollment periods listed above.

Does Part B Cover Prescription Drugs?

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 I have Part A and Part B, Do I need a Medicare Supplement plan?

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.

Get answers to your Medicare questions

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.

 

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Medicare expert Charles MacKay

Charles MacKay is the author of two health care books, including Medicare Made Easy. He has written over 300 academic papers, including many dealing with healthcare. He now lives in Pennsylvania.