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Does my elderly parent qualify for Medicare Part B?

Does my parent qualify for Medicare Part B? text over image ofExcited young man playing video games with his father and sitting on the sofa at home

Do you have questions concerning your elderly parent’s Medicare eligibility? If so, MedicareInsurance.com is here to assist you. Simply contact us online via our live chat feature or give us a call at (800) 950-0608 to learn more.

Just the Essentials…

  • Medicare is a government-managed health insurance program that is made up of of four parts: Part A, Part B, Part C, and Part D.

  • Medicare Part B covers costs related to medical expenses, such as doctor’s visits.

  • Individuals aged 65 or older may qualify for Medicare Part B, as may those diagnosed with certain disabilities or diseases.

  • Medicare Part B typically requires beneficiaries to pay a premium for treatment, though this out-of-pocket cost can vary depending on several factors.

  • Your parent may be able to reduce out-of-pocket costs for Medicare. Contact MedicareInsurance.com today to learn more about whether this possibility applies to your parent.

What even is Medicare?

Medicare is a health insurance program that is backed by the United States federal government. Typically, one becomes eligible for Medicare when they turn 65 or are diagnosed with a qualifying disability. 

Medicare is made up of multiple parts, with the two main parts being Medicare Part A and Medicare Part B, known together as “Original Medicare.” Medicare Part B specifically provides coverage related to medical treatment and services, such as doctor’s visits. 

But what elements qualify an individual for Medicare Part B? How might your parent become eligible for it? What specific treatments and services does it cover? Why might some people delay signing up for Medicare Part B? How can my parent reduce out-of-pocket costs associated with Medicare Part B? Find answers to all these questions and more right here at MedicareInsurance.com.

What is Medicare Part B?

Medicare Part B is the medical insurance portion of Medicare. Unlike Medicare Part A, which is available to most people premium-free, Medicare Part B typically requires a premium to be paid each month. Along with the monthly premium, your parent may be required to pay copayments and coinsurance on many services they receive through Medicare Part B. 

There are limits on how much a hospital or doctor can charge your parent. Luckily there are ways to reduce the out-of-pocket cost your parent pays through supplemental insurance plans or Medicare Advantage.

How does one become eligible for Medicare Part B?

Most people are eligible for Medicare Part B during their Initial Enrollment period, which occurs once one attains the age of 65 or upon the diagnosis of certain disabilities. If your parent meets specific requirements, they may be eligible to enroll in Medicare Part B up to 3 months before they turn 65, the full month of their 65th birthday, and 3 full months after their birthday month ends.

In addition, your parent may be enrolled in Medicare Part B automatically if they are already receiving Social Security or Railroad Retirement Board benefits for at least 4 months before they turn 65. 

If this isn’t the case for your parent, encourage them to instead apply for Medicare online during their Initial Enrollment Period. Application is relatively simple and can be done over the phone, or by visiting a Social Security Administration office.

Medicare Part B is also available for people under the age of 65 depending on special circumstances. For example, if your parent has a disability, they may be eligible to receive Medicare Part A and B benefits beginning the first day of the 25th consecutive month of receiving disability benefits from Social Security. In this case, the Medicare Part B premium will be deducted from their benefits check. 

Those diagnosed with End-Stage Renal Disease are also eligible to receive Medicare three months after starting dialysis. Those who have ALS will receive Medicare immediately upon receiving disability benefits.

What does Medicare Part B cover?

Medicare Part B covers services that are provided on an outpatient basis including but not limited to:

  • Lab tests
  • Preventative care screenings
  • Physical, occupational, and speech therapy, 
  • DME equipment like walkers and wheelchairs 
  • Emergency room visits

Aside from very few exceptions, such as injectable drugs administered in a doctor’s office, Medicare Part B does not include prescription drug coverage. Instead, this coverage may be available in separate parts of Medicare, such as Medicare Part C (a.k.a. a Medicare Advantage plan) or Medicare Part D: Prescription Drug Coverage.

Medicare Part B does not cover things like eye and dental care, physicals, hearing aids, and transportation. If you desire this type of additional healthcare coverage, a Medicare Advantage plan may be your best option.

What are the costs associated with Medicare Part B?

The Medicare Part B premium is based on your parent’s taxes. For  2021, the upcoming premium  is $148.50 for people who make up to $88,000 individually. If your parent files jointly with their spouse, that amount is increased to $176,000.

Medicare Part B also carries a deductible, a minimum amount of expense that must be met before benefits are obligated to pay for treatment. In 2021, the Part B deductible is $203. After the deductible is met, your parent will typically pay around 20 percent for services such as:

  • Outpatient therapy
  • Doctors services
  • DME equipment

Can my parent choose to delay Medicare Part B or drop it entirely?

Like Medicare Part A, Medicare Part B can sometimes carry a penalty if your parent does not enroll when they first become eligible. This penalty adds 10 percent to the monthly premium cost for every full 12-month period that your parent did not enroll in Part B, but were eligible. However, this penalty may be waived if your parent meets certain conditions.

For example, if your parent received health coverage through an employer or spouse’s employer during their Initial Enrollment Period, Medicare Part B enrollment may be delayed without penalty, provided the company or organization your parent or their spouse worked for has at least 20 employees.

Sometimes, one may enroll in Medicare Part B only to later decide that it is not a good coverage fit for them. Typically, this occurs when one already has separate private insurance, such as TRICARE, Veterans’ benefits, or others. 

Keep in mind that Medicare Part B is usually voluntary and your parent is allowed to drop it whenever they choose. However, Medicare advises that one fully researches and understands their healthcare coverage benefits and considers any potential penalties before deciding to do so.

How might my parent reduce their out-of-pocket Medicare Part B costs?

You will likely be pleased to know that there are actually several ways to reduce out-of-pocket costs. For example, if your parent already has another type of insurance that they are thinking about keeping, encourage them to check with the existing plan to see if this coverage may act as a secondary insurance after Medicare pays their share.

Enrolling in a Medicare Advantage or a Medigap plan is another option. Medigap is a supplemental insurance plan that works alongside Original Medicare to partially (or sometimes fully) pay for out-of-pocket expenses for services covered under Parts A and B only. 

Meanwhile, enrolling in a Medicare Advantage plan can sometimes reduce out-of-pocket costs while giving your parent access to additional benefits that are not covered by Original Medicare, such as dental, vision, and hearing coverage. It’s important to note that Medicare Advantage plans are offered by private insurance companies, and as a result, individual plans may have differences in coverage and premium costs.

To learn more about Medicare Part B and all the benefits your parent may be eligible for, contact MedicareInsurance.com online via our live chat feature, or by phone at (800) 950-0608 today to speak to a licensed agent. Our experienced insurance professionals are happy to help you research and compare Medicare plans that may be available in your area!

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