Medicare Part B medical insurance covers your expenses for healthcare related to doctors visits, whether or not you are in a medical facility. Qualifying for this coverage requires you to be a U.S. citizen or resident who is aged 65 years or older.
The cost of Medicare Part B includes a minimum standard monthly premium, the cost of deductibles, and coinsurance amounts for medical services. Enrollees must also pay for the difference in approved charges compared to what your doctor bills you. Fortunately, Medicare will cover 100% of expenses for specific treatments, including vaccines, labs, and health screenings.
Below, we review the cost of Medicare Part B, deductible amounts, and what the program will cover concerning your medical care.
In this article, we will cover:
- Medicare Part B Premiums
- Medicare Part B Deductibles
- Coverage Areas of Medicare Part B
- What You Should Know When Signing Up for Medicare Part B
Let’s start by examining the monthly premium costs associated with Medicare Part B.
What Is the Monthly Premium Cost of Medicare Part B?
Anyone enrolled in the Social Security Medicare Part B program is required to pay a monthly insurance premium that is standardized. Individuals who elect this coverage were charged a standard monthly premium rate of $135.50 in 2019. The number is expected to increase to $144.60 for 2020, or potentially even more based on your income. The standard Part B rate for enrollees is available to retirees who:
- Previously enrolled in Medicare Part B.
- Have premiums automatically deducted from Social Security payments.
- Individually has an Adjusted Gross Income (AGI) under $85,000 and $170,000 for couples.
Individuals who became divorced or widowed within the previous two years may be eligible for a reduced premium cost since a substantial drop in income may have occurred which could affect your ability to pay.
What Are the Deductibles of Medicare Part B?
Individuals who have Medicare Part B coverage cannot draw upon benefits until you pay your deductible amount for the year. The standard deductible is $185 for 2019 and $198 in 2020.
While your account administrator will keep an excellent record of what you have paid, it’s also a good idea to retain copies of your medical coverage and bill amounts in case something doesn’t seem right later down the road.
How Much Does Medicare Part B Pay?
After adding up all of your medical costs, Medicare typically pays for half of your expenses on average. If that startles you, you aren’t alone. There are a few reasons for this:
- Medicare only covers necessary medical treatments and forgoes benefits related to dental care, hearing, and vision.
- The benefits paid are based on what is determined to be an average amount in the form of approved charges.
- Doctors may not accept assignment of your costs if the approved amount is significantly less than what your doctor charges.
Supplemental Insurance to Assist with Additional Costs of Medicare Part B
While Medicare aims to cover your medical care, there are always going to be some treatment options that your doctor will require outside of the scope of your coverage. Some individuals supplement these added costs by electing coverage under a supplemental insurance program available known as Medigap.
Medigap covers the difference between what your doctor charges versus the Medicare Part B approved amounts. It does not provide benefits related to copayments, deductibles, or coinsurance amounts.
Healthcare Services Covered 80% by the Cost of Medicare Part B
Medicare Part B will elect to pay 80% of what is determined to be an approved charge relating to your routine doctor visits and medical care. That means you are responsible for the remaining 20% in the form of a coinsurance amount.
In addition to the coinsurance amounts, Medicare expects you to pay the difference between the approved amount and the actual costs for services rendered by your medical care providers. Fortunately, there are legal limitations in place that ensure your medical and healthcare costs stay in check.
Healthcare Services Covered 100% by the Cost of Medicare Part B
In addition to the services covered under the 80% deductible amounts, there are specific coverage amounts that Medicare Part B covers 100%. This information means that you are not required to pay the 20%copay when receiving treatment under the following situations:
- Home healthcare: Medicare Part B covers 100% of home healthcare services and does not cost you an annual deductible. However, equipment and devices related to treatment are not included and default under the 80% coverage rate.
- Lab services: Part B will pay 100% of the lab and clinical tests requested by your doctor, including blood tests, biopsies, and urinalyses.
- Preventive screening: You are not expected to pay for any examinations by a doctor who is screening you for specific health conditions or diseases.
- Pneumonia and flu vaccinations: While providers aren’t required to accept the assignment of influenza and pneumonia vaccines, they are typically covered by Medicare Part B. You may have to find a provider who takes your insurance. Otherwise, you will pay a 15% charge on what Medicare approves.
There are additional services and treatments that the cost of Medicare Part B covers for eligible enrollees. You can find out more about included treatment options by visiting the Medicare website.
What to Know About Signing Up for Medicare Part B
There are special enrollment periods when signing up for Medicare Part B. Your ability to elect coverage depends on your Medicare eligibility, and keep in mind that your total household income (THI) determines how much you’ll pay in terms of a monthly premium. Not all services are covered, so it is critical that you carefully plan for your healthcare needs while considering potential future benefits. Conversely, if you elect too much coverage, then you may be unnecessarily paying for benefits that you don’t need.
Make sure you check with the Medicare website to determine if you meet their criteria for benefits. Don’t miss out on the benefits that you or your family members already paid during your professional careers.
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