Medicare Part B Rules, Coverage, and Eligibility

Medicare is the health insurance program for people in the United States who are 65 years or older. In cases where people are younger than 65, eligibility is based on disabilities and serious health issues. The Medicare program helps to cover the cost of health care but will not cover all medical expenses. It will also not pay for the costs associated with long-term care.

Medicare Part B Rules, Coverage, and Eligibility

Medicare funds are provided by the payroll taxes paid by employees and their employers. Medicare is also partially financed by the monthly premiums deducted from Social Security benefits. Coverage is divided into four parts: Part A Hospital Insurance, Part B Medical Insurance, Part C Medicare Advantage, and Part D Prescription Drug Coverage.

How Medicare Part B Works

To have Medicare Part B coverage, the insured must pay a premium each month. Payments are calculated either at the standard rate for those who can afford it or based on a modified rate for lower income levels. The information will be based on your adjusted gross income from your income tax return. In some cases, those who make higher incomes will have to pay more than the standard premium rate.

How to Get Medicare Part B Coverage

There are different requirements based on an applicant’s needs to determine eligibility.

Under 65 and Disabled – In this category, coverage is automatically provided after disability benefits are approved from Social Security Administration for 24 months. Approximately three months before the 65th birthday, a Medicare card will be sent via mail or it will be sent in the 25th month of disability payments.

Receiving Social Security Benefits – Medicare Part B will start automatically from the first day the individual turns 65. This also includes those receiving benefits from the Railroad Retirement Board.

ALS (Lou Gehrig’s disease) Patients – Benefits for people with this disease automatically get Medicare Part B coverage on the month other disability benefits start.

If an individual is not interested in obtaining Medicare Part B coverage, instructions are provided with the card to decline coverage, which includes sending the card back. Individuals who fail to return their card will be obligated to pay Plan B premiums.

Costs of Medicare Part Coverage

Medicare Part B coverage costs will depend on what type of Medicare plan an individual is enrolled, Original Medicare or Medicare Health Plan. For some medical services there are no costs to the card holder. For other services, there may be out of pocket payments required. If there is a deductible associated with the Plan B coverage an individual carries, they will be required to pay all costs until the yearly deductible is met before Medicare will make payments. Once deductibles are met, generally cardholders will pay 20% of the service charges for Medicare-approved medical services.

What Is Covered Under Plan B

There are typically two kinds of Part B-covered services. Medicare Part B coverage includes medically-required services like doctor visits, outpatient care procedures, home-health services, and other medical services used to diagnose and treat medical conditions.

Medicare Part B also covers preventative services used to prevent illnesses or detect health issues at the early stages where treatment is likely to rectify the problems.

Click here for Medicare Prescription Drug Plan Finder.

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