Medicare Part B (Medical Coverage)

Medicare Part B is health insurance coverage including medical care and supplies within two types of services: medically necessary services and preventive services.

Medically necessary services include services or supplies required for diagnosing and treating your condition, in compliance with recognized standards of medical practice. Preventive services is the type of care which focuses on preventing illness and on the early diagnosis of illnesses. Part B care may include:

• Clinical research
• Ambulance services
• Durable medical equipment (DME)
• Mental health care (including inpatient, outpatient and partial hospitalization)
• Limited outpatient prescription drugs
• Part-time or intermittent home health care and home rehabilitation services
• Vaccinations
• Screenings for disease and other medical conditions, including cardio-vascular disease, cancer, diabetes and more

For a complete overview of the preventive care services and other benefits included in Medicare Part B coverage, please speak with our insurance agent or consult the “Medicare and You” Medicare handbook.

Anyone who qualifies for Medicare Part A is eligible for a Part B plan by enrolling and contributing to the monthly premium. If you are ineligible for Part A coverage, you may still qualify for Part B coverage if you meet the following requirements:

• You are age 65 or older
• You are a U.S. citizen
• You have permanent residence and have legally resided in the United States for a minimum of five uninterrupted years

You may also be eligible for automatic enrollment in Medicare Part B if you have a disability. If you are under the age of 65 and receive disability benefits, you will be automatically enrolled in Medicare Part A and Part B following the completion of 24 months of disability benefits.

You may be eligible for Part B enrollment prior to the age of 65 if you suffer from either of the following conditions:

• End-stage renal disease (ESRD)
• Amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease)

You will be eligible to enroll in Medicare Part B when you turn 65 years old. If you retire or qualify for Medicare before the age of 65 due to a disability, you will be automatically enrolled in Medicare Parts A and B beginning the month of your 65th birthday.

If you do not enroll in Part B during the initial enrollment period and do not qualify for a special enrollment period, you will be able to enroll during the general enrollment period. General enrollment runs from January 1st to March 31st, with insurance protection commencing on July 1st. Please be aware that you may incur a late fee if you do not enroll when you are first eligible.

If you do not automatically enroll, you may apply for Medicare through Social Security. This may be done in person at your local Social Security office, online via the Social Security website, or by calling 1-800-772-1213 (TTY user 1-800-325-0778) from 7:00 a.m. to 7:00 p.m. Monday through Friday.

If you are 65 or older and have Part B health insurance, you may enroll in Medigap during the six-month open registration period. This is a good time to purchase supplemental insurance plans, such as Medicare Advantage, as during your open enrollment period you have the “guaranteed right” to buy any Medigap plan with no need to purchase medical insurance coverage or pay higher premiums due to a pre-existing condition. This is a one-time initial guaranteed enrollment period after enrolling in Medicare Part B.

You may qualify for Medicare Part A without paying a premium fee. However, most individuals are required to contribute a monthly premium towards Medicare Part B. This premium causes some individuals to opt not to enroll in Part B during their initial enrollment period when they are still covered by an employer group pay.

Should you choose to delay registering for Part B healing insurance due to currently being covered through your employer, you may register later during a special enrollment period. You can enroll in Medicare Part B at any time provided you have group coverage through your existing employer’s plan group (or through the employer of your spouse).

After the end of your employer’s health coverage or the end of your employment (depending on which comes first), there will be a special enrollment period of eight months in which you can enroll in Medicare Part B without a late penalty.

Please note that coverage for retirees and COBRA is not considered health coverage based on current employment and will not qualify you for a special enrollment period. If you benefit from COBRA, do not wait until your COBRA coverage expires before enrolling in Part B coverage.

Medicare Part B premiums are subject to change from year to year and amounts payable can vary based on your circumstances. For many individuals, the premium will be automatically deduced from your social security benefits. There are separate premiums for each income level, so your premium may be higher if your income is higher.

If you are receiving benefits from Social Security, the Railroad Pension Board or federal retirement benefits, your Part B premium may be deducted directly from your regular monthly benefit. If not, you will be invoiced quarterly (every three months).

Please be aware that there may be a late registration penalty applied if you did not register for Part B Medicare when you became eligible. For example, monthly premiums can be 10% greater for every 12-month qualifying period you were eligible but did not enroll in Part B coverage.

If you have questions about monthly premiums, please speak with our insurance agent.

When your doctor or other health care provider approves an assignment for any covered service you will be responsible for the Part B deductible and for 20% of the Medicare-approved rate for the services rendered. You will be responsible for any cost beyond the Medicare coverage for the services you receive.

We recommend that you contact our insurance agent or your plan for further details, as restrictions, copayments and limitations may be applicable, and benefits are subject to change without prior notice on January 1st of each year.