Whats Not Covered Under Medicare Part B
Original Medicare doesnât cover every medical service. Part A and Part B usually donât cover:
- Most dental care
- Routine foot care
- Most prescription medications
- Care outside the U.S.
Medicare Supplement plans, such as Part D for medication coverage, can help fill in the gaps . You can often get additional benefits through a Medicare Advantage plan as well. Known as Part C, these Medicare-approved plans are offered by private insurance companies. Theyâre a kind of âhybridâ between government insurance and private insurance, says Donovan.
Your New Social Security Payment Wont Necessarily Be Exactly 87% More Than What You Currently Receive
Out with the old, in with the new. Many Americans will be glad to move past 2022 and begin a new year. And they only have a week left before theyll do so.
Retirees, in particular, have an extra reason to celebrate the new year. Theres a huge Social Security increase coming in 2023. How much will your check be?
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What Is Medicare Part B
Medicare Part B helps cover medical services like doctors’ services, outpatient care, and other medical services that Part A doesn’t cover. Part B is optional. Part B helps pay for covered medical services and items when they are medically necessary. Part B also covers some preventive services like exams, lab tests, and screening shots to help prevent, find, or manage a medical problem.
Cost: If you have Part B, you pay a Part B premium each month. Most people will pay the standard premium amount. Social Security will contact some people who have to pay more depending on their income. If you don’t sign up for Part B when you are first eligible, you may have to pay a late enrollment penalty.
For more information about enrolling in Medicare, look in your copy of the “Medicare & You” handbook, call Social Security at 1-800-772-1213, or visit your local Social Security office. If you get benefits from the Railroad Retirement Board , call your local RRB office or 1-800-808-0772.Learn More:
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Why Should You Purchase Medicare Supplement Plan K
Plan K is unique among Medigap plans because of its annual deductible.
There is no limit to your annual out-of-pocket expenses with traditional Medicare. You may control your annual healthcare spending by purchasing Medicare Supplement Plan K. This is especially useful for those who:
- having a lot of money paying out of pocket for medical care every year, usually because of a chronic illness
- to protect themselves financially in the event of a catastrophic medical emergency
Dont Lose Your Coverage
As long as you dont cancel your health insurance, it will never go away for as long as youre retired. If you do choose to cancel your insurance, you will never be able to re-enroll in a health insurance plan through the Federal Employees Health Benefits Program. If you want to try a different plan such as Medicare Advantage or Tricare, you may suspend your coverage and still retain the right to re-enroll in the FEHB. To learn more, visit opm.gov/retire.
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If You Dont Enroll When Youre First Eligible You May Pay A Late Enrollment Penalty
If you and your spouse are both retired, you may pay a late enrollment penalty if you dont enroll in Medicare Part B when youre first eligible.
The penalty is a 10% premium increase for each year you delay enrollment.
You also usually have to wait for the annual Medicare General Enrollment Period to sign up if you choose to enroll later.
What Is Medicare Part K
Medigap Plan K is a type of Medicare Supplement Insurance that helps pay for some of the costs not covered by Original Medicare . Plan K medicare supplement is unlike other Medigap plans in that it only pays a percentage of the total cost of covered services. However, this lower coverage does help keep premiums low.
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Medicare Part B Premium Reimbursement
IMPORTANT:
If your 2023 Medicare Part B premium is more than the Standard amount , you must provide EUTF with a copy of the letter you and/or your spouse/partner received from the Social Security Administration or Medicare showing your higher premium due to income-related monthly adjustment amounts. EUTF will reimburse the amount stated on the letter . If EUTF does not receive the SSA or Medicare letter from you, your reimbursement will be the standard $164.90 per month for 2023.
How Are Medicare Advantage Premiums Changing For 2023
According to CMS, the average Medicare Advantage premiums is expected to be about $18/month in 2023 , which is down from $19.52/month in 2022 and $23/month in 2020. Average Advantage premiums have been .
The average premiums described above account for all Medicare Advantage plans, including those that dont have integrated Part D coverage. And the overall average is driven down due to the fact that the majority of Advantage enrollees actually have no premiums other than the cost of Part B . If we only consider the Advantage premiums for plans that do include Part D and that do have a premium in addition to the cost of Part B, the average premium is quite a bit higher .
More than 29 million people had Medicare Advantage plans in 2022. Enrollment in these plans has been steadily growing for more than 15 years, and CMS expects that to continue in 2023, with enrollment projected to reach 31.8 million people. The total number of Medicare beneficiaries has been steadily growing as well, but the growth in Medicare Advantage enrollment has far outpaced overall Medicare enrollment growth. In 2004, just 13% of Medicare beneficiaries had Medicare Advantage plans. That had grown to more than 46% by 2022.
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What Is The Average Cost Of A Medicare Advantage Plan
The average premium for a Medicare Advantage plan in 2021 was $21.22 per month. For 2022 it will be $19 per month. Although this is the average, some premiums cost $0, and others cost well over $100. For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
Enrolling In Medicare With A Disability
Just like when you become eligible for Medicare at age 65, when you are eligible with disability, you have an Initial Enrollment Period of 7 months.
Your Initial Enrollment Period will begin after you have received either disability benefits from Social Security for 24 months or certain disability benefits from the Rail Road Retirement Board for 24 months.1 In other words, your IEP starts on the 25th month of disability benefits.
You will be automatically enrolled in Medicare Part A and Part B, but if you decide you want to get a Medicare Advantage or Part D prescription drug plan, you will need to enroll yourself directly with the private plan provider. You will need to enroll during your IEP to avoid late enrollment penalties.
NOTE: If you become eligible for Medicare because of ALS or ESRD, your situation is different. See the below special sections for eligibility and enrollment for ALS and ESRD.
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What Original Medicare Doesn’t Cover
Original Medicare doesn’t cover everything. With a few exceptions, Original Medicare doesn’t include coverage for prescription drugs. It also does not cover health care benefits you may have been used to getting with an employer plan such as dental, vision, hearing health care or wellness items like fitness memberships.
Whats The Difference Between Medicare Part A And Medicare Part B
Part A is the hospital services part of Medicare. This benefit covers inpatient care, hospital stays, skilled nursing facility care, hospice care, and medically needed home health care services.
Part B is the medical services part of Medicare. It covers many of the medically necessary services not covered in Part A, such as outpatient and preventive services. This involves things like x-rays, bloodwork, doctors visits, and outpatient care. It will also cover other medical items such as diabetic test strips, nebulizers, and wheelchairs.
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Can You Qualify For Medicare If Youre Under 65 Years Old
Most Americans become eligible for Medicare on their 65th birthday.
You may be able to receive Medicare coverage if youre under age 65 and:
- received disability benefits for 24 months
- limited stays in a skilled nursing facility
If youre eligible for premium-free Medicare Part A, theres often very little downside to enrolling. You may be eligible for premium-free Part A if you paid into Medicare through payroll taxes for at least 10 years of employment.
If you work for a large company with more than 20 employees, a Medicare policy can act as a secondary payer and can help to fill in gaps in your existing coverage without any additional cost on your end.
If you work for a small company or have a health insurance plan through your employer with minimal coverage, enrolling in Medicare may help reduce your medical expenses.
Medicare will often become the primary payer in these cases and may provide better coverage than you currently receive. In fact, your small employers insurance may not cover you if they discover youre eligible for Medicare benefits and havent enrolled.
In many cases, its best to apply for Medicare Part A when you become eligible, even if youre covered by a group health plan. Delaying enrollment in Part A may lead to a penalty if you sign up later.
What Services Does Medicare Part B Cover
The following services are included:
- Doctor visits or appointments with other health care providers, including some doctor services when hospitalized
- Diabetes care, including education, certain equipment, prevention programs and screenings
- Diagnostic tests including CT scans, electrocardiograms, MRIs and X-rays
- Durable medical equipment, such as wheelchairs and walkers, that your doctor prescribes for use in your home
- Emergency department and outpatient surgery center services as well as other outpatient hospital services
- Some health programs, such as cardiac rehabilitation, obesity counseling and smoking cessation
- Laboratory services, such as blood and urine tests
- A limited number of prescription drugs that you usually dont administer yourself
- Outpatient mental health services
- Outpatient physical therapy, occupational therapy, and speech and language pathology services
- Preventive care, such as flu shots and mammograms, to help avert illness or detect it at an early stage. Many preventive services are covered without deductibles or copayments.
- A Welcome to Medicare checkup and the annual wellness visit, which are covered in full without deductibles or copayments, unless additional tests are ordered.
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Helping You Prepare For Whats Next
When it comes to Medicare, theres a lot to consider. To help you make the most informed decision, weve provided some important information you can use to better understand how Medicare works and when youre eligible to enroll.Keep in mind that if youre already a member of FEP and you choose to combine your coverage with Medicare,* youll get additional benefitsplus coverage for services that Medicare does not cover.
Can I Reject Part B Altogether
Part B is optional. You can choose to skip it altogether and avoid the premiums. But that means youre on the hook for the full cost of any services that would otherwise be covered under Part B. For healthy enrollees, that might amount to the occasional office visit and nothing more. But if you end up needing extensive outpatient care such as kidney dialysis, chemotherapy, radiation, physical therapy, etc. your bills could add up quickly.
As noted above in the discussion about late enrollments, you will have a chance to sign up for Part B each year, regardless of how long youve delayed enrollment. But the late-enrollment penalty could become substantial, depending on how long youve been without Part B coverage. And if and when you do decide to enroll, youll have to wait until the January-March general enrollment period. So going without Part B when you dont have other coverage from an employers plan is an option, but its a fairly risky option.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.
How does the hold harmless provision protect beneficiaries from Medicare Part B premium increases?
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Medicare Part B Special Circumstances
Some people dont need Medicare Part B coverage right away, because they have medical insurance through their employers or meet other special conditions. And some people choose not to enroll in Medicare Part B, because they dont want to pay for medical coverage they feel they dont need. There are a variety of reasons why you might hesitate to pay for medical insurance. Likewise, you may be concerned about how the new healthcare laws affect Medicare Part B coverage. In this section, well discuss a few reasons to hold off on Medicare Part B, as well as how Obamacare affects Medicare Part B coverage.
For starters, people who are still working when they qualify for Medicare may not need to get Part B coverage right away. If you have insurance through your employer, then you most likely already have medical coverage. However, you should still meet with your plan administrator to find out how your current insurance works with Medicare, because some policies change once youre eligible for Medicare. Other special situations include the following:
Once you stop working or lose your work-based coverage, you have an eight-month period to enroll in Medicare Part B. If you dont enroll during this time, you may have to pay the late enrollment penalty every month that you have Part B coverage sometimes indefinitely. Also, you may face a serious coverage gap if you wait to enroll.
Will There Be Inflation Adjustments For Medicare Beneficiaries In High
Yes. The threshold for high-income surcharges is increasing for 2023, although the premiums that people pay for Part B are decreasing, and that includes people who pay the high-income surcharge.
Medicare beneficiaries with high incomes pay more for Part B and Part D. But what exactly does high income mean? The high-income brackets were introduced in 2007 for Part B and in 2011 for Part D, and for several years they started at an income of $85,000 .
But the income brackets began to be adjusted for inflation as of 2020. For 2023, the threshold where the surcharge starts to be added is increasing again, to $97,000 for a single person and $194,000 for a married couple, up from $91,000 and $184,000, respectively, in 2022. The significant increase for 2023 is due to the fairly high inflation weve seen in 2022. .
For 2023, the Part B premium for high-income beneficiaries ranges from $230.80/month to $560.50/month, depending on income .
As part of the Medicare payment solution that Congress enacted in 2015 to solve the doc fix problem, new income brackets were created to determine Part B premiums for high-income Medicare enrollees. These new brackets took effect in 2018, bumping some high-income enrollees into higher premium brackets.
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When Can I Sign Up For Plan K
Plan K is available during the Medigap Open Enrollment Period, which begins when a person reaches 65 and lasts for six months. To sign up for a Medigap policy, they must enroll in Medicare Part B.
Regardless of health status, anyone can purchase Medigap Plan K during this enrollment period. Theyll pay the same rate as those in perfect health.
A person may not purchase a Medigap policy after the open enrollment period has ended. This is since, following the Open Enrollment Period, Medicare authorizes businesses to employ medical underwriting. An individuals risk is calculated using their demographic information and information about their health and lifestyle.
Using this method, a business can determine whether or not to offer coverage to a customer and, if so, at what cost. Insurance premiums may be more costly if a business decides to offer them.
Enrollment Limits
A persons other health coverage does not affect their guaranteed issue rights for Medigap insurance.
Suppose a persons Advantage plan departs Medicare or coverage in their area is discontinued, for instance. In that case, they will be eligible to enroll in a Medigap policy with the same benefits as those available during the Open Enrollment Period.
Comparing Parts B And C
Medicare Part C is an alternative to original Medicare that private insurers administer. However, the federal government contracts them. Medicare Part C, or Medicare Advantage, bundles benefits from Parts A, B, and D.
People with an Advantage plan do not also need Part B, as they will already have the benefits under their bundled coverage.
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Special Circumstances: Medicare With Als Or End
Medicare eligibility rules for people with ALS or end-stage renal disease are different. Individuals who qualify for Medicare with ALS or ESRD do not have to wait for your 25th month of disability to be eligible for Medicare.
If you qualify with ALS: You will automatically get Medicare Part A and Part B the month your disability benefits begin.7
If you qualify with ESRD:8
- For most people, Medicare coverage will start on the 1st day of the 4th month of dialysis treatment.
- If you have an employer group health plan, Medicare will begin on the fourth month of dialysis.
- Treatments if you have employer coverage.
- If you participate in an at-home dialysis training program, your coverage may begin the first month of a regular course of dialysis provided the following are true:
- You participated in training from a Medicare-approved training facility for the first three months of your regular dialysis
- Your doctor expects you to finish training and be able to do your dialysis treatments yourself
Note, according to Medicare in order to qualify with ESRD all of the below must apply:9
For further information related to ALS and Medicare, visit www.alsa.org.
For further information related to ESRD and Medicare, visit www.medicare.gov.