What is Medicare Part B?

Medicare Part B is the Medical Coverage portion of “Original Medicare.”

Medicare Part B covers all medically necessary procedures outside of an admitted Hospital stay(Part A). Medicare Part B covers- All Medically Necessary Medical Services outside of an admitted Hospital In Patient Stay(Part A). Services Include- Doctor Visits including Primary Care and Specialists Diagnostic Tests Like Mri’s, CT Scans, Xrays and Blood Work Durable Medical Equipment like Wheel Chairs, Hospital Beds or a Cane and Crutches Out Patient Care Home Health Care Preventative Care like Vaccines, Screenings and Annual Wellness Tests Chemo and other injectables received in a Doctors office or Facility Dialysis

What Does Medicare Part B Cost?

Medicare Medical Part comes with a Monthly Premium of $185.00 in 2024. Some individuals could pay as much as $628.00 or in between depending upon their income. The additional cost is called an Income Related Monthly Adjustment Amount(IRMAA). Social Security will look back 2 years and base your Part B Premium on that income year. If your income is lower than 2 years ago a “Life Changing Event” form may be filed with Social Security and you can get the premium lowered to the base amount of $164.90. (See IRMAA below).

The Cost Share for Medicare Part B is as follows:

Annual Deductible– You will be responsible for the first $257.00 of your Medical coverage.
Cost Share– After the deductible has been satisfied Medicare will then pick up 80% of all costs and you are responsible for the 20% coinsurance. Care should be taken when considering using Part B alone without Health Insurance. Considering Cancer Treatments like Chemo Therapy can run in the Hundreds of Thousands and the 20% coinsurance could be astronomical.
Talk to your Medicare Advisor, he’ll guide you to the plan that’s appropriate for your individual needs and help put a plan in place to limit your annual Medical costs.

ADJUSTMENT FORM

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Choosing the Right Medicare Coverage

Selecting the best Medicare coverage depends on factors like your healthcare needs, budget, and preferred providers. You can choose between:

Original Medicare (Parts A & B): Allows you to see any doctor or
hospital that accepts Medicare but does not include prescription drug
coverage (Part D) or additional benefits.
Medicare Advantage (Part C): Offers bundled coverage with
potential extra benefits but may require using a network of providers.
Medigap (Medicare Supplement Insurance): Helps cover
out-of-pocket costs not covered by Original Medicare, such as
copayments and deductibles.

Key Medicare Enrollment Periods

It is crucial to enroll in Medicare at the right time to avoid penalties and ensure continuous coverage:

Initial Enrollment Period (IEP): A seven-month window starting
three months before your 65th birthday month.
General Enrollment Period (GEP): From January 1 to March 31
each year for those who missed their IEP.
Annual Election Period (AEP): From October 15 to December 7,
allowing you to switch or enroll in Medicare Advantage and Part D
plans.
Open Enrollment Period(OEP): From January 1 to March 31 for
those who missed AEP and want to make certain changes.
Special Enrollment Period(SEP): Can be used anytime during the
calendar year for those that meet certain criteria such as moving to a
new service area.

Finding Help with Medicare

Understanding Medicare can be complex, but you don’t have to do it alone. Licensed Insurance Brokers, Medicare.gov, and state health assistance programs can provide guidance tailored to your specific needs.

By taking the time to explore your Medicare options, you can make informed decisions that ensure you receive the healthcare coverage that best suits your lifestyle and budget.

Do I have to sign up for Medicare?

It depends upon your current coverage. If you are employed and your employer has over 20 employees then you can delay signing up for Medicare and avoid penalties.

Does Medicare cover Prescription Medications?

No, You will have to enroll in a stand alone Part D plan or a Medicare Advantage Plan(Part C) to get coverage.

I want to be able to go to any doctor/hospital, are there networks with Medicare?

There are no networks with Medicare and most doctors and hospitals accept it. However, Medicare does not cover 100% of services so a Medicare Supplement or Medicare Advantage plans is advisable.

Mike Miligi- Owner

For over 10 years, Mike has been assisting Seniors and other Medicare-eligible individuals in understanding the ins and outs of Medicare and Medicare Health Insurance options, including Medicare Advantage Plans(Part C), Medicare Supplement Plans(Medigap), Prescription Drug Plans(PartD), and Dental and Vision programs.

Mike is Licensed in seven States and Certified with 11 Insurance Carriers. He has helped thousands of individuals decide on the best course of action for their particular Health Insurance needs. Because Mike is an Independent Medicare Health Insurance Broker, he works for the client, not the Insurance Carriers, and is able to provide his clients with accurate and unbiased Health Insurance options.

Mike recertifies with CMS(The Centers for Medicare and Medicaid Services) annually, regularly completes Continuing Education Courses required by individual State Insurance Departments, and keeps abreast of industry trends and standards to offer his clients the most up-to-date information.