What You Should Know About Part B

What does Part B cover.

Part B covers Medically necessary services or supplies that are needed to diagnose or treat a medical condition. It is also covers, health care to prevent illness or detect illnesses at an early stage when treatment is most likely to work best.

Most Doctor services, including Doctor services while you are an inpatient hospital, outpatient therapy and durable medical equipment, clinical research, ambulance services, mental health and limited outpatient drugs are covered.

Enrollment and Late Enrollment Penalty

If you are just turning 65 your enrollment period is 3-month before and 3-months after your 65th birthday. If you have End-Stage-Renal disease you can enroll but coverage does not start until 4-months after treatment begins. If you leaving an employer paid health care plan you will have a special enrollment period to enroll.

If you do not enroll when first eligible or after leaving employment, there will be a late enrollment penalty. The penalty is 10% for each full 12-month period you did not enroll into Part B and you have specific months the following year before coverage starts.

Premium

In 2021 the standard premium is $144.60. Higher incomes will pay the IRMAA amount. After your deductible is met, you pay 20% of the Medicare approved amount for most doctor services. Most Medicare Advantage plans pay the deductible and you pay a co-pay or coinsurance.

Income Related Monthly Adjustment Amount (IRMAA) Premium

Higher earners will pay a higher monthly premium per person, per month based on the last two years calculated income tax filings.

$87,000-$109,00 individual or $174,000-218,000 joint will pay $202.40

$109,000-$136,000 individual or $218,000-$272,000 joint will pay $289.20

$136,000-$163,000 individual or $272,000-$326,000 joint will pay $376.00

$163,000-$500,000 individual or $326,000-$750,000 joint will pay $462.70

Filings greater than $500,000 individual or $750,000 joint will pay $491.60

Medicare Access and CHIP Reauthorization Act (MACRA)

MACRA is a value-based program designed to prevent Physicians from threating to leave or leave the Medicare parogram due to reimbursment reductions. 

What this means is that if you are enrolling in a Medigap or Supplemental plan and you just turned 65, starting January 1, 2020 you will have to pay the MACRA yearly premium without a rider. Enrollees over 65 prior to January 1st 2020 can still add a rider to their policies.

The yearly deductiable is $198 and once satisfied the enrollee pays 20% of Medicare approved cost, unless an additional rider is on the policy.