Medicare Part B

Medicare is a federally sponsored program designed to provide individuals age 65 and older, and those with qualifying disabilities with health care insurance.  The entire program is split into two parts.  Medicare Part B is medical insurance that helps these individuals pay for the costs of doctor bills and outpatient medical care.  Part B also covers some of the medical services that Medicare Part A (hospital insurance) doesn't cover.

Enrolling in Medicare Part B

You can choose not to enroll in Medicare Part B, but if you want to, there are three distinct ways of enrolling.  If you are eligible for Social Security or Railroad Retirement benefits, then you are automatically enrolled in Part B starting on the first day of the month in which you turn age 65.   That being said, the three ways of manually enrolling in Medicare Part B include:

Initial Enrollment

The initial enrollment period for Medicare Part B starts three months before the month in which you turn age 65 and ends six months later, which is three months after the month you turn age 65. Please note that although the some people may not be eligible for full Social Security benefits until after the age of 65.  This does not affect your Medicare eligibility at age 65.

General Enrollment

If you decide not to sign up for Medicare Part B when you first become eligible, then you can take advantage of the general enrollment period each year.  General enrollment runs from January 1st through March 31st of each calendar year.  If you sign up for Medicare Part B during general enrollment, then your coverage will begin on July 1st of that same year.

If you've delayed enrolling in Medicare Part B, then you may have to pay an additional percentage of the premium.  We'll explain this in more detail later in the section on premiums and deductibles.

Special Enrollment

The special enrollment period is for those individuals that were eligible for Medicare, but decided to wait to enroll in Medicare Part B because they had health care coverage through their employer or a spouse's employer.

If this circumstance applies to you, then you can apply for Medicare Part B anytime you are still covered by a healthcare insurance plan.  You can also apply during the eight months following the month your health plan coverage ends or when employment ends - whichever comes first.

If you sign up for Medicare Part B during your special enrollment period you do not have to pay an additional amount towards your premium.  However, if you do not sign up during special enrollment and sign up during general enrollment, an additional premium may apply.

Medicare Part B Coverage

Medicare Part B is designed to pick up where Medicare Part A leaves off.  That means Part B will cover certain medically necessary services such as non-routine doctor visits, outpatient surgery and suppliers, diagnostic tests and items that are termed durable medical equipment.  This includes wheelchairs, walkers, oxygen equipment and in-home hospital beds.

Under certain conditions, Medicare Part B can also cover second and even third opinions for surgery that isn't considered a medical emergency.  Part B will also cover the costs of laboratory services for things such as blood tests and some screening tests in addition to urinalysis.

If the patient requires home health care services, the cost of these expenses are also covered by Medicare Part B.  This includes reasonable and necessary skilled nursing care, health aid providers, physical therapy, and durable medical equipment such as wheelchairs and walkers.

Medicare Part B Preventative Services

Starting back in January 1, 2005, the Medicare program expanded the preventative care services offered under Part B insurance to include:

• Bone Mass Measurements - qualified individuals can have their bone mass measurements taken as a preventative measure every 24 months.
• Cardiovascular Blood Screening - starting in 2005, qualifying patients are eligible for blood tests for cholesterol, lipid or triglycerides and other tests used to detect the onset of cardiovascular disease.
• Colorectal Cancer Screening - includes sigmoidoscopy (every 48 months), colonoscopy (every 24 months for high risk patients, 10 years otherwise), and Barium Enema (every 24 months for high risk, 48 months otherwise).
• Diabetes - starting in 2005, Part B includes screening test such as plasma glucose for certain individuals at risk.
• Glaucoma - once every 12 months when performed or supervised by an eye doctor that can legally provide the service.
• Pap Test and Pelvic Examination - high risk individuals can have these tests once every 12 months including a clinical breast examination.
• Prostate Screening - includes digital rectal examination and PSA test once every 12 months for men age 50 and over.
• Mammograms - once every 12 months for women age 40 and older.
• Immunizations - includes the flu shot (once per season), pneumonia, and hepatitis B.

Finally, the preventative services offered under Medicare Part B also includes a "Welcome to Medicare" physical examination.

Medicare Part B Premiums, Deductible and Coinsurance

In 2007, the Medicare Part B monthly premium was raised from $88.50 to $93.50.  The increase was in part due to the rising cost of medical care, but also includes the cost of supplying some of the recently introduced preventative care benefits.  In 2008, monthly premiums will rise to $96.40.

If you've delayed enrollment in Medicare Part B past the Initial Enrollment Period, your premium may be up to 10% higher for each 12 month period you've delayed.  These increases are applied to your monthly premium for life.

The deductible for Part B is $131.00 per year in 2007 and was be indexed to the average increase in costs associated with Part B services starting in January 2007.  In 2008, the Medicare Part B deductible will rise to $135.00 per year.

After the deductible is satisfied, there is a 20% coinsurance payment due on all Medicare Part B covered services.  Our article on Medicare Supplemental Insurance may provide you with information to help in control your deductible and coinsurance payments within the Medicare program.

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