Medicare Part B is the other half of what is known as Original Medicare. We’ve already talked about its counterpart, Medicare Part A, on its own separate page. So if you’re here, that means you’re ready to find out about what is included with your Medicare Part B healthcare benefits.

What is Medicare Part B?

Medicare Part B is also known as the “medical insurance” part of Original Medicare. It helps pay for most of your health care costs which involve outpatient hospital care, outpatient surgeries and rehab, and also your basic medical checkups. Most seniors purchase Medicare Part A and Part B together, but there are circumstances under which that might not be an ideal situation. It all depends on your costs, eligibility, and your exact retirement date, among other factors.

How Much is Medicare Part B?

In 2022, the standard monthly premium for Medicare Part B is $170.10. The cost does go up depending on your income, but you won’t have to pay more than the standard premium unless you alone make more than $91,000 or you and your spouse jointly make more than $182,000. Most seniors have this premium automatically deducted from their social security benefits, so it’s not a direct out-of-pocket cost.

The annual deductible for Medicare Part B in 2022 is $233. This is a direct out-of-pocket cost. But once you meet your deductible – which is not difficult to do, given the cost of health care these days – you will only pay a 20% cost share for the Medicare-approved price of all your medical care going forward for the rest of the calendar year.

If you enroll in Medicare Part B late, you will be subject to a late enrollment penalty. That penalty takes your monthly premium for Part B and adds a 10% surcharge for each year that you did not enroll in after the age of 65. So a person who only pays the standard premium and waits a year to enroll after their Initial Enrollment Period will have to pay an additional $17.10, for a grand total of $187.20 per month.

Who’s Eligible for Medicare Part B?

Since Medicare Part B is voluntary, there are different eligibility requirements. If you qualify for premium-free Medicare Part A, then you also qualify for Medicare Part B. Just keep in mind that if you enroll in each part separately, there are specific dates for enrolling in Medicare Part B. You can’t just join anytime you want.

If you have to pay for Medicare Part A, then you must be at least 65 years of age, a resident of the country, and either a legal citizen or a lawfully admitted, permanent resident alien with at least five continuous years of residency prior to filing your Medicare application.

People who are under the age of 65 with a qualifying medical disability like Lou Gehrig’s Disease or ESRD can also qualify for Medicare Part B. Contact your local CMS office for more information.

What Does Medicare Part B Cover?

Medicare Part B covers two very important things: medically necessary services, and preventative services. Medically necessary services include anything – in addition to medical services and supplies – that you need for the diagnosis or treatment of a medical condition. Preventive Services include yearly wellness check-ups, flu shots, or standard medical tests designated to detect diseases early, thus reducing the cost of treatment and the likelihood of bad outcomes.

You can also count on Part B for the following:

  • Durable medical equipment
  • Ambulance services
  • Clinical research
  • Mental health services, including inpatient, outpatient, and partial hospitalization services
  • Limited outpatient prescription drugs

What Does Part B Not Cover?

Medicare Part B does not cover your health care costs associated with any inpatient hospital treatment. It also does not cover any of the benefits explicitly outlined in Medicare Part A, including hospice care, skilled nursing facilities, and home health care services.

How to Sign Up for Part B?

For anyone who is about to turn 65 and is currently receiving Social Security benefits, your enrollment will be automatic and you should receive your Medicare card in the mail within three months of your 65th birthday.

If you are not eligible for automatic enrollment, you will have to wait to apply with your local CMS office. For Part B, you can only enroll during your Initial Enrollment Period, the annual General Enrollment Period, Or a Special Enrollment Period.

FAQs

We understand that Medicare can be complicated for a lot of people. It’s almost inevitable that most seniors who read this page will still have questions. We hope we can answer some of them in the FAQ below. You can also contact us directly if you feel like we have not sufficiently answered any of your questions here.

What is the Part B premium for 2022?

In 2022, the standard Medicare Part B premium is $170.10.

What is the income limit for Medicare Part B?

The standard premium applies to individual seniors making less than $91,000 per year or a senior couple filing jointly who both make less than $182,000 per year. It scales up based on your income to a maximum monthly premium of $578.30 for seniors who make more than $500,000 per year by themselves or a senior couple making more than $750,000 per year filing jointly.

Why do I need Medicare Part B?

Not all seniors need to enroll in Part B immediately. If you still have good insurance through your employer which takes care of your medical insurance needs, you can wait to enroll in Part B until you are no longer covered by your employer’s insurance. Just make sure you file all the paperwork correctly once you do transition into Part B, or you may be subject to a late enrollment penalty.

Does Medicare Part B cover prescriptions?

As stated above, there are certain limited prescriptions that Part B will pay for if it is necessary and related to your outpatient care. Otherwise, you’re going to have to rely on Medicare Part D.

Do you always have to pay for Medicare Part B?

Yes. You will have to pay the monthly premium as well as the annual deductible and your 20% coinsurance costs for as long as you are enrolled in Medicare Part B.

Can I cancel Medicare Part B?

Yes, you can volunteer to end your Medicare Part B benefits. But you will likely be subject to a personal interview with a Social Security representative from the CMS office.

by Lindsay Malzone, Lindsay Malzone is the Medicare expert for Medigap.com. She's been contributing to many well-known publications as an industry expert since 2017. Her passion is educating Medicare beneficiaries on all their supplemental Medicare options so they can make an informed decision on their healthcare coverage.
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