An overview of Medicare Part B

 

You don't have to sign up for Medicare Part B, but most people do. It helps pay for doctor office visits, outpatient care in hospitals and clinics (when you are not admitted for an inpatient stay), laboratory tests, some diagnostic screenings and skilled nursing care

Nursing care that should be provided only by a licensed nurse.

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Part B also covers most doctor services you receive as a hospital inpatient, although other hospital services are covered by Part A. And, to help keep you healthy, Medicare Part B covers some preventive care

Care that is meant to keep you healthy, or to find illness early, when treatment is most effective. Examples of preventive care are flu shots, screening mammograms and diabetes screenings.

such as an annual physical exam and certain preventive screenings at no cost to you.

What providers can you see with Medicare Part B?

You can choose any doctor or health care provider who is eligible to participate in Medicare and who is accepting new patients.

Medicare Part B costs

Medicare Part B premium

Most people pay a monthly premium for Medicare Part B. The premium amount depends on your yearly income. If you receive Social Security, the premium will be automatically deducted from your Social Security benefits. For 2012, Part B premiums range from $99.90 to $319.70 per month.

Important: You may pay a penalty if you don’t sign up for Part B when you are first eligible. Your cost for Medicare Part B may go up 10% for each full 12-month period that you could have had Part B but didn’t sign up for it. You’ll pay that penalty for as long as you’re enrolled in Part B.

This penalty may not apply to you if you are still working for an employer who provides group health coverage or if you have other credible coverage when you become eligible for Medicare.

Medicare Part B cost sharing

Medicare Part B deductible

Before Part B begins paying a share of your costs, you must first pay the deductible each year. In 2012, your deductible is $140 for the year.

Medicare Part B copay

Outpatient hospital services have copays that can range from a few dollars up to $1,156 in 2012.

Medicare Part B coinsurance

After you pay your deductible, Medicare Part B shares the cost of your care with you. Part B generally pays 80% and you pay 20% as coinsurance.

In Part B, you’ll pay a share of the cost of your care as you receive it. You’ll pay the same share whether you need a little care or a lot.

What is Original Medicare - Parts A & B

<span style="font-size:10px">View Decision Guide</span>

This simple chart shows you how the different parts of Medicare work together.

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Which Medicare plan is right for you?

Original Medicare (Parts A & B)

A federal health insurance program for people 65 and older, and for those younger with a qualifying disability or special circumstances.

Part A

Medicare Part A

Helps cover hospital stays and skilled nursing services, plus other skilled care—including hospice care.

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Part B

Medicare Part B

Helps pay for doctor visits and other outpatient services, like lab tests and diagnostic screenings.

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Optional add-ons to Original Medicare

Original Medicare doesn't cover everything and it doesn't include prescription drug coverage. You may want a Medicare plan offered by private insurance companies to fill the gap:

Part D

Part D (Prescription Drug Plan)

Plan costs, drugs covered and pharmacy choices vary.

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Medicare Supplement

Medicare Supplement Insurance Plan (Medigap)

Pays for some of the costs Original Medicare (Parts A and B) does not play. Benefits vary. You must have Original Medicare to apply for a Medicare supplement insurance plan.

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OR

Medicare Advantage (Part C)

Costs and benefits vary by plan and location.

Part C

Medicare Advantage

Includes the same coverage you would get with Original Medicare and may include extras like vision, hearing and dental care, as well as gym memberships, often for no additional cost. Most plans include prescription drug coverage. You must be enrolled in Original Medicare and continue to pay your Part B premium.

Part A + Part B + Part D + Extras

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Included Additional Add-Ons to Medicare Advantage


Vision

Dental

Fitness

Optional add-ons to Medicare Advantage

Not all Medicare Advantage plans offer prescription drug coverage. If the Medicare Advantage plan you're interested in does not include drug coverage, you may choose to switch to a Medicare Advantage plan that offers drug coverage. Some Medicare Advantage plan types (PFFS plans) allow members to enroll in a standalone Part D prescription drug plan, as well.

Part D

Part D (Prescription Drug Plan)

Plan costs, drugs covered and pharmacy choices vary.

Learn More