Silver American Medicare Plans –

your tool for navigating the path to Medicare

Medicare Part B Coverage

Medicare Part B Insurance Coverage and Services

Medicare Part B generally covers two main types of service. The first is medically necessary services and supplies that are needed to treat or diagnose your medical condition. These must also meet accepted standards of medical practice. The second type of service that Medicare Part B covers is preventive services to help discover issues early when treatment is most likely to work best. For example, some shots and vaccines are covered.

Medicare Part B Enrollment Periods

You can enroll in Medicare Part B medical insurance during the (IEP) Initial Enrollment Period, which begins three months before your 65th birthday and extends through the three months that follow your birth month. There is also a (SEP) special enrollment period for those who are covered by a group health plan offered by a union or employer.

If you are already receiving benefits from Social Security or the Railroad Retirement Board, you will be automatically enrolled in Medicare Part B the first day of the month you turn 65. Anyone who is not receiving Social Security or RRB benefits when they turn 65 must enroll in Medicare through Social Security.

If your birthday is on the first of the month, you will enroll in Medicare Part B on the first day of the previous month. If you are disabled and under the age of 65, you will likely automatically get Medicare Part B once you receive Social Security disability benefits. Most people must pay a monthly premium, the cost of which may change depending on their income, to ensure Medicare Part B coverage. The premium is usually deducted from your monthly Social Security payments, depending on income.

If you were automatically enrolled in Medicare Part B and received a card in the mail, you can choose to opt out by sending the Medicare Part B card back: by keeping the card, you keep Medicare Part B and keep paying Medicare Part B premiums. If you signed up for Medicare through Social Security, contact Social Security.

If you chose not to enroll during your Initial Enrollment Period, you will have the opportunity to sign up during the General Enrollment Period, which lasts between January 1 and March 31 each year. In many cases, if you don’t sign up for Medicare Part B when you’re first eligible, you have to pay a late enrollment penalty. For every one year period that you were qualified to enroll in but opted not to, your Medicare Part B monthly premium increases by 10 percent. You pay this penalty for the entire time you have Medicare Part B. If you meet certain conditions that allow you to sign up during the Special Enrollment Period, you may not have to pay this enrollment penalty.

Medicare Part B Outpatient Care and Treatment

Medicare Part B provides patients with medically necessary outpatient health care. Physician services, nursing services, vaccinations, cardiovascular and diabetes screenings, lab services, and other preventive services are all covered by Medicare Part B. In addition, Medicare encourages all beneficiaries to complete an annual Wellness Visit…Medicare Part B will not pay for cosmetic surgery, custodial care, prescription drugs, dental or vision care, as well as some other services.

Medicare does not cover every health-related service or item. You may have co-payments and deductibles on services even if they are covered by Medicare. After you meet your deductible, your co-payments will generally cost around 20% of the Medicare-approved amount for most doctor services. If a service you need is not covered by Medicare, you must cover the costs yourself unless you have separate insurance that does.

Contact Us