What is Medicare Part B all about?
Medicare is the federal insurance program that pays for health care for individuals over the age of 65 and younger people with specific chronic illnesses. Medicare has several parts, including Part A (hospitalization) and Part B (medical coverage and outpatient services). U.S. citizens get Part A coverage for free once they reach age 65.
Who Is Eligible for Medicare Part B?
Medicare is the primary health insurance program for many American seniors. Individuals aged 65 and over are the majority of users of the Medicare program. To qualify, an individual must have worked 40 quarters (10 years) and paid into Medicare in their lifetime. Individuals under the age of 65 may also receive Medicare coverage if they have a disability, amyotrophic lateral sclerosis (ALS) or end-stage renal disease (ESRD).
What Is Covered by Part B?
While Part A focuses on inpatient services, Part B covers many medically necessary services that do not require hospitalization. These do not include daily living assistance, such as nursing care that helps with bathing and eating. Among the services that are covered by Part B are doctors' visits, physical therapy, blood tests, X-rays, CT scans, MRIs, equipment such as wheelchairs and walkers, and emergency room services.
The specific services covered by Part B are not the same in every area of the U.S. Medicare coverage is offered through private service providers. If you want to know whether a specific item or service is covered by Medicare, you can use the search function at Medicare.gov to find out.
When Are You Eligible to Enroll in Part B?
You can enroll in Medicare starting three months before reaching the age of 65, the month you turn 65 and three months after. This is called Open Enrollment. If you miss this period, there is a special election period Jan. 1 to March 31 every year with coverage beginning July 1. Part B is optional, however, if you plan to enroll in Part B at a later date, you may have to pay a penalty if you enrolled after you were originally eligible. Your premium will cost 10 percent more for every 12-month period that you didn't sign up for Part B but were eligible. In other words, if you wait two years before signing up for Part B, you pay the standard premium rate plus an additional 20 percent. If you wait three years, it's an additional 30 percent, and so on.
Some seniors can access a special enrollment period and as a result, avoid this penalty. The special enrollment period is during which you are under a group health plan and currently employed or the eight-month period after which the first of either your employment or the group health plan enrollment ends. In essence, as long as you are covered by your employer and still working for that employer, the clock does not start ticking in terms of the late enrollment penalty for Part B if Medicare deems that you have creditable coverage.
What If I Get Social Security?
If you will get Social Security or Railroad Retirement Board benefits starting at least four months before you turn 65, you do not have to sign up for Part A or Part B Medicare. These seniors are automatically enrolled in these programs, except those living in Puerto Rico, who must apply separately for Part B regardless of when their Social Security benefits begin. People getting disability benefits through Social Security or the RRB also do not have to sign up for Part A or Part B, as they received coverage for 24 months after these benefits begin.
What If You Live Outside the US?
If you live outside the U.S. and are over the age of 65, you may still be eligible for Part B Medicare coverage. In general, you can only apply between January 1 and March 31 of each year. You also incur the late enrollment penalty. However, if you're over 65, did not live in the U.S. when you turned 65, are not eligible for social security and are a U.S. citizen, you can get Part B coverage once you return to the U.S. to establish a residence. If all of those factors apply, you do not have to pay the late enrollment penalty as long as you sign up for Part B within three months of your return.
Medicare is one way to ensure you have access to the health coverage you need. Learning the details about how Medicare Part B works can help you to decide when to enroll and what options to choose.
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