What is Medicare Part B?

Medicare Part B is the side of Medicare that covers medical services and items. Where Part A covers hospital care, Part B covers medical necessities such as doctor visits, bloodwork, equipment, and more. Medicare Part B is optional. Part B of Medicare is meant to complete your medical insurance coverage not covered under Part A.

Medicare Part B helps cover:

• Services from doctors and other health care providers Medically necessary services you receive from a licensed health professional.
• Ambulance services and emergency transportation, typically to and from hospitals. Coverage for non-emergency transportation is limited to situations in which there is no safe alternative transportation available, but is medically necessary.
• Home health care serves, such as if you are homebound and need skilled nursing or therapy care.
• Durable medical equipment This is equipment that serves a medical purpose, is able to withstand repeated use, and is appropriate for use in the home. Examples include walkers, wheelchairs, and oxygen tanks. You may purchase or rent DME from a Medicare-approved supplier after your provider certifies you need it.
• Many preventive services (like screenings, shots or vaccines, and yearly “Wellness” visits) In most cases, preventive care is covered by Medicare with no coinsurance.
• Therapy services, specifically outpatient physical, speech, and occupational therapy services provided by a Medicare-certified therapist.
• Mental health services.
• X-rays and lab tests.
• Chiropractic care, specifically when manipulation of the spine is medically necessary to fix a subluxation of the spine.
• Select prescription drugs, including immunosuppressant drugs, some anti-cancer drugs, some anti-emetic drugs, some dialysis drugs, and drugs that are typically administered by a physician.

Part B Costs, Premiums, Deductible and Co-pays

Medicare’s Part B is optional and is financed largely by monthly premiums paid by individuals enrolled in the program. Most people will pay the standard premium amount, which was $174.70 each month in 2024. The premium for 2025 is likely to change, though has not been announced yet. Medicare policyholders may have this premium automatically deducted from their Social Security check. The premium is income based, however. If you have a higher income, you will pay more than the standard premium. If you don’t sign up for Part B when you are first eligible, you may have to pay a late enrollment penalty.

You can check your Medicare eligibility and premiums on Medicare’s official website.

Part B has an annual deductible requirement, as well. Each year, before Medicare pays anything, the patient must pay equal to the deductible, based on Medicare’s approved “reasonable charge.”

After the Part B policyholder meets their deductible, Medicare Part B will pay 80% of the “reasonable charge” for covered services. You, as the policyholder, are responsible for 20% as “co-insurance.” Keep in mind that the “reasonable charge” is often less than the provider’s actual charge. If the provider agrees to “accept assignment,” he agrees to accept Medicare’s “reasonable charge” rate as payment in full and the patient is only responsible for the remaining 20%. If the provider does not accept assignment, you are responsible for paying some of the difference between Medicare’s reimbursement rate and the provider’s actual charge.

Whether or not someone who is eligible for Medicare should take Part B depends on how the person receives his or her insurance benefits. Medicare can be either primary or secondary to other insurance.

What if I am still working? When should I defer?

If you or your spouse continue to work past age 65, and receive health benefits from your employer, you are entitled to defer Part B without penalty.

When you defer, you:

• Won’t need Part B until either you or your spouse loses your employer-provided health coverage, through retirement or otherwise.
  
• Save Part B premiums and avoid penalties.
• Are required to submit proof of employment in addition to a Part B application.

After deferring, you should then begin to sign up for Medicare Part B or a Medicare Advantage plan 3 months before you or your spouse. This ensures you have the smoothest transition possible and avoids penalties.