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Who is eligible for Medicare Part B?

Who is eligible for Medicare Part B? - Medicare Enrollment Form

Just the essentials...

  • Medicare Part B eligibility opens a wide array of insured medical services

  • In combination with hospital insurance of Part A, it forms the comprehensive Original Medicare system

  • Near the 65th birthday, Americans can enroll in Part B and pay premiums

  • Designated disabled persons can get Part B without delay

  • SSA and RRB beneficiaries under 65 get automatic enrollment

Older Americans are the main beneficiaries of Medicare Part B. Persons with limited abilities qualify. End Stage Renal Disease and Amyotrophic Lateral Sclerosis qualify at any age. Other eligible persons under 65 receive benefits from Social Security and the Railroad Retirement Board. They get an automatic eligibility after 24 months of benefits.

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Medicare Part B is the Medical Services Portion of Medicare

Who is eligible for Medicare Part B?

The Congress intended Medicare to be a comprehensive health care system for older Americans. The Original Medicare-focused on hospital-based care and outpatient care. The Congress later added Medicare Advantage to provide greater choice and variety for Medicare users.

They came back nearly 40 years later to complete the structure with prescription drug benefits. They reflected the benefits of the medical services of Part B in Part C where private plans must meet or exceed the coverage of Original Medicare.

  • Eligible persons include those ages 65 or older, and persons with ALS or End Stage Kidney disease.
  • Parts A and B make the Original Medicare.
  • Medicare Advantage brought private plans to compete with Original Medicare.
  • Part B can combine with Part A, Part D, and a Medicare Supplement policy to form a powerful coverage and health care financing support for older Americans.

Understanding Part B

Medicare Part B is medical insurance. It covers outpatient care including doctor’s services, skilled nursing, and durable medical equipment. The Centers for Medicare and Medicaid administer Part B. When combined with Medicare Part A, it comprises the Original Medicare. The below-listed items are the major categories of Medicare Part B.

  • Outpatient services
  • Durable medical equipment
  • Occupational and physical therapists
  • Prosthetics, orthotics, and medical supplies

The Individual Mandate

Who is eligible for Medicare Part B?

Part B standing alone will not meet the requirements of the individual mandate of the Affordable Care Act. It does not have the minimum essential coverage required by the Affordable Care Act. The below listed Medicare Parts and combinations meet the individual mandate.

  • Medicare Part A
  • Medicare Parts A and B
  • Medicare Advantage

No Free-Part B

Medicare eligibility comes with age and physical status. Part A can be premium -free for those with 40 covered quarters of work experience. Part B requires payment before it can start.

Social Security beneficiaries can get the premium deducted from their benefit. Those outside of social security must pay in advance and then maintain monthly premium payments.

Dropping Part B Leads to Penalty

Those that have Part B automatically or by request can drop it. Like those that wish to pass on taking it, both groups can face a penalty later when getting Part B.

Part B has a premium, and that is a major decision in whether to accept it. The average premium in 2016 was about $120 per month. Unlike Medicare Part A, there is no premium-free Part B based on work history.

The Part B Penalty

Who is eligible for Medicare Part B?

The Part B penalty is ten percent of the premium per month for the life of the enrollment. The penalty exists because those that do not accept Part B when they can do not pay the premiums that they would have paid. The lack of funds has a consequence for the system. Medicare Part B gets its operating revenues in part from the premium payments from eligible recipients.

The Part B Deductible

Part B has an annual deductible amount which users must pay before Medicare will pay its share of costs. In 2016, the Part B deductible was $168. The deductible precedes cost-sharing in Part B. A typical cost-share divides the costs of a service by an 80 percent to 20 percent balance.

The 20 percent balance can build up as users take more services than planned or expected. For some users, the 20 percent coinsurance payments create barriers to getting the care they need. For them, a Medicare Supplement can help.

Medicare Supplement and Part B

Medigap or Medicare Supplement are private insurance plans authorized by the federal government with state government oversight. As insurance companies, states must authorize and review their activities. Medicare Supplement can pay the gap between part B coverage and the consumer’s responsibility.

Typically an eighty percent to twenty percent split. Medicare Supplement comes in letter-labeled plans from A through N, with fewer options in many states. Some also cover foreign travel. Medicare Supplement can save an individual’s budget in the event of unexpected medical expenses under Part B.

Deferring Part B

Who is eligible for Medicare Part B?

Some people age 65 or older continue to work and get coverage from an employer-sponsored program. They may wish to pass on buying Part B. These persons can get a deferral for buying Part B. They can qualify for a special enrollment period at the end of their employer coverage. They can apply for Part B alone, but they will have to have Part A also.

Enrollment in Part B

The Initial Enrollment Period runs from three months before the 65th birthday month through three months afterward. The initial enrollment is the best time to make enrollment choices because of the greater number of options and the avoidance of late selection penalties.

  • Open enrollment runs from October 15 through December 7 of each calendar year. Applicants can get Medicare Supplement, Original Medicare, Medicare Advantage, and Part D Prescription Drugs.
  • General Enrollment runs from January 1 through March 31 of each year.
  • Special Enrollments follow qualifying events that include a change in status and losing employer-based health insurance coverage.

How to Enroll in Part B

One can enroll in Part B during periods open to enrollment or a special period for some qualifying change in status. One can enroll in Part B at a social security office, a local Medicare office, by mail, by telephone, or online with Social Security or Medicare. The below-listed items qualify for special enrollment in Parts A and B.

  • Moved to a new location not served by the existing plan
  • Recently returned to the US from abroad
  • Recently lost employer-sponsored job coverage
  • Existing plan no longer certified by Medicare
  • Enrolled in coverage that is better than Medicare
  • Enrolled in an all-inclusive program like PACE

Older and Disabled Americans are Eligible for Medicare Part B

There will be a significant difference in the costs of Parts A and B depending upon the number of covered quarters of work, but those aged 65 can get Part B coverage. The individual history will determine the costs; disabled persons can get it automatically.

Once they have Part B, consumers may wish to decide to use private all-in-one plans instead. Comparison shopping will help consumers make the best selection of private plans in Medicare Part C, Part D, and Medicare Supplement.

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