Who Qualifies For Medicare Part B and What Does Medicare Part B Cover?

Posted by Elliot Marks

Everyone knows that when they reach age 65, they're eligible for Medicare. There are so many parts, though, that it confuses newly eligible seniors. Part A is the hospitalization portion of Medicare, with Part B being the doctor's care portion. Let's examine Part B to see what it covers along with any changes or updates for 2020.

What Is Medicare Part B?

Medicare Part B is part of Original Medicare meant to give seniors access to medical services. Part B is basically anything requiring a physician or medically necessary equipment such as oxygen or a wheelchair.

Why Are You Required To Pay For Part B?

During your working years, you paid taxes against the time you'd receive Medicare Part A. This isn't true of Part B. Some automatically get Part B, but if you don't, you'll have to sign up for it.

You'll pay a premium depending on your income. If you make $87,000 or less annually, you'll pay $144.60 monthly premium. If you're married filing joint tax returns and make $174,000, you'll pay the same premium. Your deductible will be $198. When you meet this deductible, you'll pay 20 percent of the charges for doctor visits, outpatient services, and medically necessary equipment.

Those making more than $87,000 up to $109,000 or married couples making $174,000 up to $218,000 will pay a premium of $202.40 monthly.

Of those making $109,000 up to $136,000 or married couples making $218,000 up to $272,000 will pay a monthly premium of $289.20.

People making $136.000 up to $163,000 or married couples making $272,000 up to $326.000 will pay a monthly premium of $376.

Those making $163,000 up to $500.000 or married couples making $326,000 up to $750,000 will pay $462.70 each month.

If you make more than $500,000 or married couples making $750,000, then you'll pay $491.60 each month.

The deductible for any and all Medicare Part B insured is $198.00.

Your copay or coinsurance will be 20 percent of the charge. For instance, if your doctor charges you $50 for an office visit, your copay or coinsurance would be $10.00. For a prescription costing $25.00, you would pay $5.00.

When should I sign up for medicare part B?

When Should You Sign Up For Part B?

Most people approaching age 65 will automatically receive Medicare Parts A and B. If you are disabled and receiving disability payments, you are automatically eligible for Parts A and B. If you have to sign up, though, you must be 65 years of age and sign up during the general enrollment period between January 1 to March 31.

You can enroll at a Social Security office in your neighborhood, or you can go online to the Social Security website at https://www.ssa.gov. You can also call 1-800-772-1213 to talk to a human. TTY folks can call 1-800-325-0778. All calls can be made 7 am to 7 pm Monday to Friday.

Is Medicare Part B Taken Out Of Your Social Security Check?

Yes. The Social Security Administration or SSA will compute the cost of living increases in your Social Security payment, compute the resulting change in Medicare Part B charges, and take it all out of your Social Security check each month. It comes out automatically, so you don't have to worry about how you'll come up with the money.

Social Security Benefit Eligibility

It's important to make sure that you're eligible for Social Security retirement benefits. The following guide will help you determine whether you qualify.

Social Security Eligibility

Is Any Of This Tax Deductible?

Always discuss this with a tax professional. They know each change that occurs each tax year, and can lead you through it. Yes, the premiums for Part B are tax deductible as they are part of your medical expenses. To deduct them, your medical expenses have to be ten percent over your Adjusted Gross Income.

What Does Medicare Part B Cover?

We said above that Part B was basically doctor coverage. We need to add a few things to that. For example, if you're taken to a hospital in an ambulance, does the hospitalization portion of Medicare pay for the ambulance? No, but Part B does. Who pays for your yearly flu shot? Part B does.

Part B covers things outside your doctor's office such as wellness visits, mammograms, colonoscopies, lab work, chiropractic care, and home health care.

In terms of lab work, Part B pays for diagnostic imaging like MRI and CAT scans and drugs administered during testing for whatever shows up on the imaging. Cancer, surgeries, and chemotherapy are covered by Part B.

Outpatient care is paid for by Part B. This includes medical care and testing taking place inside an urgent care facility, doctor office, ER, or even a hospital. You are not admitted to a hospital for outpatient care.

Preventive care

Preventive care is covered by Part B and includes whatever will land you in a hospital for which Part A would have to pay. Some of these include:

  • Drug and alcohol screening and counseling
  • Diet counseling
  • Diabetes counseling
  • STD screening and counseling
  • Smoking cessation screening and counseling
  • Cholesterol and blood pressure screening
  • Anxiety and depression counseling
  • Aspirin for prevention of heart attack
  • Colorectal cancer screening
Does Medicare Part B cover preventative care for women?

Preventive care exclusively for women include:

  • Anemia, Rh incompatibility and other blood conditions screening
  • Anything to do with pregnancy screenings
  • Breast and cervical cancer screenings and mammograms
  • Contraception
  • Osteoporosis screening
  • Domestic violence screening and counseling

Home health care and medically necessary equipment are self-explanatory. If you have Part B for over one year, it will pay for an annual wellness visit. Your primary care physician administers this wellness visit in which you both plan a wellness program to prevent illness. This typically includes diet, exercise, rest, fresh air, and possible anxiety mediation such as mindfulness.

What Part B Doesn't Cover

To be fair, you should know that Part B fails to cover certain things. Hospital visits are covered by Part A and prescription drugs by Part D. Skilled nursing is covered under some Medigap programs, as is dental, vision, and hearing testing and glasses or hearing aids. Hospice care is covered elsewhere but not by Part B. Basically, Part B is strictly about your health and where you go to maintain it. Learn more about medicare and social security here!

Elliot Marks

Elliot Marks

Author & Social Security Advisor

Elliot Marks has spent over 10 years providing clear and concise information to help Americans navigate the complex nuances of social security and many other government services in the United States. Elliot has a passion for helping those in need of these services to be able to find timely access to news and information that is relevant and helpful to their daily lives.