Medicare Part B: Medical Insurance
Medicare Part B is a part of Original Medicare that covers outpatient care, preventive services, and medically necessary services and supplies. It helps with healthcare needs outside of hospital stays and is considered essential for those who want coverage for routine and specialized medical care.
What Does Medicare Part B Cover?
- Medically Necessary Services
- Preventive Services
- Outpatient Care
- Mental Health Services
- Home Health Care
What Medicare Part B Does NOT Cover :
- Routine dental, vision, or hearing care (e.g., glasses, dentures, hearing aids).
- Prescription drugs (covered by Part D or Medicare Advantage plans).
- Long-term care or custodial care.
- Cosmetic procedures.
- Most alternative medicine services (e.g., acupuncture, except for certain conditions like chronic low back pain).
Who is Eligible for Medicare Part A?
Age 65+: Most U.S. citizens or permanent residents qualify at age 65 if they or their spouse paid Medicare taxes.
Under 65: Eligible if you have certain disabilities, such as receiving Social Security Disability Insurance (SSDI) for 24 months, or conditions like End-Stage Renal Disease (ESRD) or ALS..
Enrollment Periods for Part B
1. Initial Enrollment Period (IEP)
- A 7-month window starting 3 months before your 65th birthday month and ending 3 months after.
2. General Enrollment Period (GEP)
- January 1 – March 31 every year, with coverage starting on July 1 (if you missed IEP).
3. Special Enrollment Period (SEP)
- Available if you delay Part B due to having employer-sponsored health insurance.
- SEP lasts 8 months after losing employer coverage or stopping work.
Costs for Medicare Part B (2025):
1. Monthly Premium
Standard Monthly Premium: $174.70 in 2025.
- Higher-income individuals pay more based on Income-Related Monthly Adjustment Amounts (IRMAA).
- IRMAA applies if your modified adjusted gross income (MAGI) is above $103,000 (single) or $206,000 (joint).
2. Annual Deductible
Deductible for 2025: $240.
- You must pay this amount before Part B starts paying for services.
3. Coinsurance
- After meeting the deductible, Medicare pays 80% of the approved amount, and you pay 20% for most services.
- There is no annual out-of-pocket maximum under Original Medicare, so costs can add up if you require frequent services.
Eligibility for Medicare Part B
- Automatically enrolled if you receive Social Security or Railroad Retirement benefits when you turn 65.
- If not automatically enrolled, you can sign up during specific enrollment periods.
Late Enrollment Penalty
If you don’t sign up for Part B when you’re first eligible, you may pay a 10% penalty for each 12-month period you were eligible but didn’t enroll. This penalty is added to your monthly premium for as long as you have Part B.
Schedule Your FREE Consultation
If you’re ready to take the next step, call 786-970-6539 or e-mail me at topqualitym@gmail.com to book an appointment with me. I proudly serve Florida and can help you find the Medicare coverage you need!