Medicare Part B helps pay for doctor office visits, outpatient care in hospitals and clinics, laboratory tests and some diagnostic screenings, and some skilled nursing care. Part B insurance is not required, but most people enroll in it.
Part B covers many of the doctor services you receive as a hospital inpatient (the hospital services are covered by Part A) Medicare Part B also covers most common preventive health care treatments and checkups. The preventative care helps keep you healthy so you and the government can avoid costly treatment and hospital stays.
Medicare Part B Works with Your Health Care Provider
Your Medicare Part B coverage is very flexible. You can choose any eligible Medicare doctor or health care provider accepting new patients. It’s that simple.
Medicare Part B Premiums
Unless you qualify for low income assistance through Medicaid, you will be required to pay a monthly premium for your Medicare Part B coverage. The amount of your premium is based on your annual income.
If you are receiving Social Security, your Part B premium fees will be paid directly from your Social Security benefits (monthly deduction). Each year the premiums adjust slightly. For 2012, the range is $99.90 to $319.70 per month.
If you are about to become eligible, don’t delay signing up. If you do, you may be penalized with higher costs. The federal government may increase your premium by up to 10% for each full 12-month period that you were eligible for Part B but didn’t enroll in it. It’s not a one-time penalty. You’ll continue to pay the higher rate for as long as you’re enrolled. If you are still working and your employer offers group health coverage, the penalty may not apply. Check with your benefits adviser to be sure.
Is Medicare Part B Necessary?
If you or your spouse are still working and you have health coverage through your employer or your union, contact your benefits administrator to find out how your coverage works with Medicare. It may be to your advantage to delay Part B enrollment.
You can sign up for Part B any time you have current employer health coverage. However, be aware that COBRA and retiree health coverage are not considered current employer coverage.
When your employment ends, three important things happen:
- You have 8 months to enroll in Part B without incurring a penalty. This period has nothing to do with COBRA coverage, so don’t wait. If you miss your 8 month window, you will not be allowed to enroll until the next General Enrollment Period and you will be without coverage.
- You may be able to get COBRA coverage, which continues your health insurance through the employer’s plan for up to 18 months, albeit at a much higher cost to you. If you already have coverage through a COBRA plan, it will end when you enroll in Medicare. If you have End‑Stage Renal Disease (ESRD), your situation may be different, so consult your benefits adviser.
- When you sign up for Part B, your Medigap Open Enrollment Period begins.
If you have TRICARE (insurance for active‑duty military and military retirees), you are required to enroll in Medicare Part B to keep your TRICARE coverage.
How Medicare Works With Other Insurance
When you have other insurance, such as employer group health coverage or TRICARE,
there are rules that determine who pays first. The insurance that pays first is known as the primary payer and the one that pays second is the secondary payer.
The primary payer always pays up to the limits of its coverage. The secondary payer only pays when there are costs the primary payer didn’t cover. The secondary payer may not pay all of the uncovered costs, in which case you will be required to make up the difference. If your employer insurance is the secondary payer, chances are that you will need to enroll in Part B before your insurance will pay.
For medical care expenses related to accident or injury, other insurance policies will be required to pay before Medicare. These include:
- No-fault insurance (including automobile insurance)
- Liability (including automobile insurance)
- Black lung benefits
- Workers’ compensation
Be aware that Medicaid and TRICARE are never the primary payer for services covered by Medicare. They only pay after Medicare, employer group health plans, and Medicare Supplement Insurance providers have paid to the limits of those polices.