Claire Smith Last Updated On: June 27, 2023

How Medicare Part B Works?

Medicare Part B is an important part of the full Medicare program that covers outpatient care. This coverage goes beyond your care if you are recovering from a serious disease or surgery: Medicare Part B takes care of everyday outpatient expenses too, and, as a result, is invariably valuable for many.

But do you need it?

That’s the million dollar question, and we’re going to help answer it for you here and now. From how to apply to eligibility to other Medicare Part B frequently asked questions, we’ve got you covered.

Medicare Part B Covers Your Doctor Visits

Medicare Part B insurance is that part of original Medicare that covers your regular health care and supplies. A few examples of what Medicare Part B may cover are ambulance services, part-time or intermittent home health care, and doctor visits and supplies that are doctor ordered. Durable medical equipment and outpatient rehabilitative services are also part of Medicare Part B health insurance coverage.

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Table of Contents

Below Coverages Are Included In Medicare Part B

  • Health Provider Services – Doctors, nurse practitioners, occupational and physical therapists as well as mental health programs are all examples of licensed healthcare providers covered by Medicare Part B.
  • Durable Medical Equipment – Walkers, wheelchairs oxygen tanks and other durable devices bought or leased from a Medicare approved supplier and authorized by your healthcare provider.
  • Home Healthcare Services – Part-time and intermittent services if you are homebound and unable to receive them at an outpatient facility.
  • Ambulance Services – Emergency to and from the hospital, also when no alternative medically safe option is available.
  • Preventive Services – Screenings and counseling designed for prevention and maintaining good health.
  • Therapy – Outpatient physical, speech, and occupational therapies as ordered by a physician.
  • Chiropractic Care – For manipulation of the spine only.

What Is Medicare?

First, a quick refresher on Medicare in general.

Medicare is a government-funded healthcare plan for people over the age of 65 and those with specific disabilities.

You become eligible for Medicare if:

Medicare comes in four different forms: Plan A, Plan B, Plan C, and Plan D.

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Medicare Part B Application Procedures

Nearing 65 years of age? If you are, you must apply for Medicare for 3 months prior to your birth month and up to 3 months after. If you already receive certain government benefits or those from the Railroad Retirement Board, your enrollment may be automatic but we recommend you check to make sure. If you have worked the required number of quarters, Part A is free but you must apply for Part B Medicare, and for this coverage, you will likely pay a premium.

Automatic Enrollment in Medicare Part B

While the eligibility requirements and coverage of Medicare Part B are rather simple, enrollment can be a little more complex. This complication is due to Part B’s accommodation of different life circumstances.

If you are an American citizen and a permanent resident of at least five years in the United States, then you will be automatically enrolled in Medicare Plan B when eligible. This means that on your 65th birthday, you will be enrolled without you having to do anything. 

Or, if you are eligible on the basis of your disabilities, you will be automatically enrolled in Medicare Plan B shortly after you qualify for disability, or when you receive either Social Security Administration (SSA) or Railroad Retirement Board (RRB) benefits.

There are exceptions to automatic enrollment eligibility and they are as follows:

  • You live in Puerto Rico (as only Part A is automatically enrolled there)
  • You have End Stage Renal Disease
  • You are over 65 but do not have SSA or RRB

In these circumstances, you will need to enroll manually.

Delayed Enrollment in Medicare Part B

There are some circumstances in which you may need to delay your enrollment in Part B coverage. Perhaps you were volunteering abroad when you turned 65, or perhaps you were still working and receiving major medical insurance coverage from your employer. In cases such as these, you can delay enrollment meaning that you can manually enroll later for Medicare without penalty. 

With Medicare Part B, you have to pay regular premiums for your coverage. Those premiums go up 10% for every 12 month period that you were eligible for Medicare but didn’t apply. It is likely that those increased premiums will remain indefinitely. 

That’s why it’s important to know how and when to enroll manually so that you do not have to pay those extra premiums. 

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Medicare Part B Manual Enrollment

There are three manual enrollment periods for Medicare Part B. Here’s a rundown of what they are. We know it can be a bit to take in at first, but once you get it, you’ve got it for good.
  1. Initial Enrollment Period (IEP):
    • For those whose eligibility is determined by age, you have a seven month period to enroll surrounding your 65th birthday. This period includes three months before your birth month, your birth month, and three months after your birth month.
    • For those whose eligibility is determined by disabilities, your initial enrolment period is between the start of your 22nd month and the end of your 28th month of receiving SSA or RRB benefits.
  2. General Enrollment Period (GEP):
    • This period occurs between January 1st and March 31st each year. You may enroll during the year you turn 65, or are qualified for disability.
    • Your Medicare Part B coverage will kick in on July 1st of the year that you enroll during the general enrollment period.
    • If you waited too long after being eligible to enroll during this period, you may receive a late penalty.
  3. Special Enrollment Period (SEP):
    • This period is for those who delayed enrollment because of their employee-sponsored work benefits. For those who are eligible by age, these work benefits must be either your own or your spouse’s. For those who are eligible by disability, these work benefits may also be from a non-spousal family member.
    • You have until eight months after you lose your work benefits to manually enroll in Medicare Part B.
    • In order to utilize your Special Enrollment Period, you should call the Social Security Administration and request the “Part B enrollment request” form, which you will complete, and the “request for employer information” form, which your employer should complete. This second form is for proof of employment benefits. Supplemental proof may be needed if your employer does not fill out this second form. This may look like this:
      • Income tax forms showing insurance premiums
      • W-2s or pay stubs that show pre-tax medical insurance premiums being withheld
      • Health insurance cards with policy date
      • Explanation of benefits
      • Statements or receipts of insurance premiums

The Takeaway: Medicare Part B

While Medicare Part B is not for everyone, it’s good to have if you have health care concerns. In the long run, these expenses can add up, cutting into your retirement savings and forcing you to choose between your health and your wealth. 

If you can afford Medicare Part B, it’s certainly worth considering, at the very least. Saving on medicare just got simple, compare your Medicare Part B quote now!

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When eligible, Medicare Plan B must be your primary coverage, meaning that COBRA will be reduced to secondary coverage. However, your dependents will not lose their primary COBRA coverage.

Only delay enrollment if necessary. Delayed enrollment should only occur if you had legitimate reason to do so such as receiving an employee sponsored health insurance plan, or volunteering abroad at the time of your eligibility coming into effect.

As has been noted, eligibility begins when certain government benefits are received or at age 65. If you are working and covered by a union or employer plan of comparable or creditable benefits to Part B you can apply at a later date with no penalty.

No, nor vision, prescriptions hearing aids or prescription drugs. Excess provider charges, acupuncture or non donated blood also are not reimbursed.

You still have several options if you missed that opportunity. Each year there is a Medicare Part B open enrollment period that allows recipients to consider optional Advantage coverage, changing their Advantage provider or a return to traditional Medicare. In addition, there are other options if you are no longer covered by a union or private plan.


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