Medicare Part B - What is it and other important information?

Second in a series of basic Medicare information, I started sort of at the end with Medicare Part D because more people were asking for information about it than parts A, B or C.  Part B is the second most searched for so here’s what I know about it.

What is Medicare Part B?
Medicare Part B is a federal health insurance program additional to Medicare Part A that helps pay for some services and products not covered by Part A, generally on an outpatient basis. This voluntary program requires a insurance premium and covers doctor and outpatient services. Medicare is a social insurance program administered by the United States government, providing health insurance coverage to people who are aged 65 and over. There are some others, under age 65, who meet other special criteria and are eligible for Part B, but this article does not cover those people. Medicare operates as a single-payer health care system.  Simply put, the American taxpayer pays the bills through the Federal government which in turn has contracts with private companies to handle the paperwork.

Medicare  is voluntary, and those who enroll in it have the premiums ($96.40 per month in 2009) deducted from their Social Security monthly payments. Part B Medicare covers charges by physicians, laboratory tests and X-rays among other non-hospital charges.  Many people with other health insurance will decline Part B Medical coverage, thinking that with the other health insurance, they may not need to pay for it. That may or may not be true. It depends on the source and type of the other health insurance. Keep in mind that if you defer signing up for Medicare Part B you may be subject to a lifetime penalty (10% per year) should you join later.

When and where do I sign up?
1. If you already get Social Security benefits - You will not need to do anything. You will be automatically enrolled in Medicare Part A and Part B effective the month you are 65. For example, if your 65th birthday is February 20, 2001, your Medicare effective date would be February 1, 2001. (Note: if your birthday is on the 1st day of any month, Medicare Part A and Part B will be effective the 1st day of the prior month. For example, if your 65th birthday is February 1, 2001, your Medicare effective date would be January 1, 2001.) Your Medicare card will be mailed to you about 3 months before your 65th birthday. If you do not want Medicare Part B, follow the instructions that come with the card. For complete information on enrollment see the Initial Enrollment Package section.

2. You want to apply for both Social Security Retirement Benefits and Medicare - If you are close to age 65 and not yet getting Social Security benefits or Medicare, you can apply for both at the same time. To make sure that your Medicare Part B coverage start date is not delayed, you should apply three months before the month you turn 65. This is the beginning of your 7 month Initial Enrollment Period. If you wait until you are 65, or in the last 3 months of your Initial Enrollment Period, your Medicare Part B coverage start date will be delayed.

To apply, you can call or visit your local Social Security office or call Social Security at 1-800-772-1213. You can apply online (using the Internet) if you meet certain rules. To apply online, visit www.socialsecurity.gov. You must answer a series of questions that will tell if you can apply online. For example, you must be at least 61 years and 9 months old; plan to start receiving Social Security retirement benefits within the next 4 months; live in the United States or one of its territories/commonwealths; agree to get your Social Security benefits by direct deposit to your bank or other financial institution. You must answer some other questions as well.

What does Medicare Part B cover?
Part B coverage includes physician and nursing services, x-rays, laboratory and diagnostic tests, influenza and pneumonia vaccinations, blood transfusions, renal dialysis, outpatient hospital procedures, limited ambulance transportation, Immunosuppressive drugs for organ transplant recipients, chemotherapy, hormonal treatments such as Lupron, and other outpatient medical treatments administered in a doctor’s office. Medication administration is covered under Part B only if it is administered by the physician during an office visit.
Part B also helps with durable medical equipment (DME), including canes, walkers, wheelchairs, and mobility scooters for those with mobility impairments. Prosthetic devices such as artificial limbs and breast prosthesis following mastectomy, as well as one pair of eyeglasses following cataract surgery, and oxygen for home use is also covered. Complex rules are used to manage the benefit, and advisories are periodically issued which describe coverage criteria.

What does Medicare Part B cost?
The monthly cost for 2009 Part B is $96.40. The amount is automatically deducted from your regular Social Security Insurance benefit each month. For 2009, higher Medicare Part B premiums apply to anyone with a modified adjusted gross income (MAGI) exceeding $85,000 for single taxpayers and $170,000 for married filing joint income tax returns.

Single Taxpayers with MAGI:
• Less than $85,000 will continue to pay 25% or $96.40 per month.
• $85,001 to $107,000 will pay 35% or $134.90
• $107,001 to $160,000 will pay 50% or $192.70.
• $160,001 to $213,000 will pay 65% or $250.50.
• Over $213,000 will pay 80% or $308.30.

Married Filing Joint Taxpayers with MAGI:
• Less than $170,000 will continue to pay 25% or $96.40 per month.
• $170,001 to $214,000 will pay 35% or $134.90.
• $214,001 to $320,000 will pay 50% or $192.70.
• $320,001 to $426,000 will pay 65% or $250.50.
• Over $426,000 will pay 80% or $308.30.

That’s all for Medicare Part B. The next article will cover Medicare Part A. I hope this helps you more than it confuses you.
Sources used for this article:
http://en.wikipedia.org/wiki/Medicare_(United_States)
http://www.hhs.gov/faq/medicaremedicaid/1668.html
http://www.cms.hhs.gov/apps/media/press/factsheet.asp?Counter=3272

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