Original Medicare consists of Part A and Part B. Original Medicare is health coverage that is managed by the United States government using a third-party administrator. Medicare Part B is outpatient medical insurance offered through Medicare, which accounts for a majority of health care coverage in the United States for those 65 and older.
Unlike Medicare Part A (inpatient coverage), which has no premium for most people, Part B requires a monthly premium. However, Medicare Part B offers a broader pallet of care to its beneficiaries. All outpatient care is the realm of Part B, including non-admitted care at hospitals, doctors, tests, therapy, injectable drugs, and more.
Who is eligible for Medicare Part B?
If you are eligible for Medicare Part A, you are automatically eligible for Medicare Part B too. You must have resided legally in the U.S. as a U.S. citizen or permanent resident for at least five consecutive years. If you haven’t yet reached age 65, you may qualify for Part B if you already receive disability benefits from Social Security or the Railroad Retirement Board. The same is true if you have Lou Gehrig’s disease or end-stage renal disease.
When should you delay enrollment?
Generally, you want to enroll in Medicare Part B when you turn 65, but this may not always be the case. For example, people who are enrolled in an employer group plan should delay enrollment because their group plan would be paying their medical expenses. People who delay Part B enrollment, for this reason, can enroll penalty-free when they lose their group coverage. This “Special Enrollment Period (SEP)” lasts eight months, starting from the day you are no longer covered. If you don’t enroll and don’t have another plan, you will pay a 10% premium penalty for every 12 months you don’t have coverage.
What does Medicare Part B cover?
Medicare Part B covers all necessary outpatient supplies or services used to diagnose and treat the beneficiary’s medical condition, as well as preventive and lab services.
Medicare Part B covers implanted material supplies such as defibrillators, diabetes supplies, kidney dialysis, and supplies as well as durable medical equipment like wheelchairs, walkers, and oxygen equipment. Part B also covers injectables you may receive at your doctor’s office, such as a B 12 shot and chemotherapy administered by an oncologist.
Medicare Part B covers ambulance services, chemotherapy, mental health care, cardiac rehabilitation, physical therapy, and second surgical opinions. Also, Medicare Part B includes coverage for various tests such as MRIs, ECG and EKG tests, X-rays, CT scans, blood tests, urinalysis, tissue sample tests. It also covers a CPAP trial for up to three months if you have obstructive sleep apnea. Additionally, Medicare Part B covers preventive services such as screenings for diabetes, depression, cardiovascular diseases and cancer, flu shots and pneumococcal shots, mammograms, alcohol misuse screenings, bone density measurements, and a yearly ‘wellness’ visit.
Although most people think of Part A as being your hospital coverage, Part B does cover some hospital-related services. Specifically, if you have not been admitted to a hospital, but you are being held on observation, Medicare Part B pays for your doctor and outpatient services. If you’re held on observation status, you will receive a Medicare Outpatient Observation Notice (MOON), which confirms your status as an outpatient. It’s important to know when you are held on observation you are responsible for the 20% coinsurance if you don’t have a Medigap policy.
Part B does not cover dental care, eyeglasses, and hearing aids. Things like cosmetic surgery, acupuncture, concierge services, or long-term care are also not covered. Part B does not generally include coverage for prescription medicine. It’s very important to know there is a 20% coinsurance on all supplies and services covered by Part B that will be your responsibility. And there is no limit on the 20%. That’s why it’s important to have some other coverage to help.
We often find that just having Original Medicare is not the best fit for our customers. It is so important to consider your individual healthcare needs, rather than merely going with a one size fits all plan. Many people find that a Medicare Advantage Plan or a Medigap Plan through a private insurance company can save them a lot of money on the type of healthcare they need instead of relying on Medicare Part B and A.