Ron M. Landsman, P.A., lawyers in Bethesda, MD, Maryland

Medicare Part B - Supplemental Medical Insurance

Medicare Part B provides supplemental medical coverage for items not covered by Medicare Part A.

How Is Eligibility Determined?

Two types of individuals are eligible for Medicare Part B coverage: (1) patients who are eligible for Medicare Part A without paying premiums; and (2) individuals older than 65 years of age who are U.S. citizens, U.S. residents, or legal resident aliens who have lived in the U.S. for at least five years.

How Do I Enroll?

Three periods of enrollment are available. First, an individual may enroll when he or she first becomes eligible for coverage; there is a seven-month window for enrollment beginning three months before individuals turn 65 years of age. Second, open enrollment is every year from January 1 through March 31, resulting in coverage effective July 1 of that same year. A third enrollment period is available for those who failed to enroll because they were covered by employer-provided group health care when they became eligible. Those individuals may enroll any time during employment or up to eight months thereafter.

Is There A Premium For Part B Coverage?

Part B coverage is voluntary, and all enrollees must pay a premium. They may choose to have their premiums deducted from certain federal government payments, including Social Security, railroad, or civil service retirement checks.

If an individual takes advantage of the open enrollment period from January through March, his or her premium increases by 10% for every year that enrollment was delayed. However, if the delay in enrollment was because the individual was covered by group health care, no premium increase occurs.

What Else Will I Have To Pay?

Part B enrollees must meet an annual deductible before coverage begins. Additionally, Part B covers only 80% of the reasonable and customary charge for services. If a provider accepts Medicare assignments, meaning that the provider has agreed to accept just the Medicare amount as its fee, the enrollee is responsible for only the remaining 20%. However, if the provider does not accept assignments, the provider may only bill for 115% of the reasonable and customary charge, as defined by Medicare. In such a case, the enrollee may be required to pay both the 20% copayment and an amount up to 15% over the reasonable and customary fee.

What Services Are Covered?

Part B covers many services and items that are not covered by Part A hospitalization benefits, including outpatient hospitalization services, ambulance transport, psychiatric hospitalizations, and emergency room visits. Part B also covers some testing, including Pap smears and mammograms, as well as certain types of treatment, including physical, occupational, and speech therapy and some aspects of home health care. Finally, Part B covers certain types of equipment, including breast prostheses after a mastectomy is performed, prescribed durable medical equipment, some braces, and one pair of glasses after cataract surgery is performed.