What To Expect From Medicare Part B Coverage

Key Takeaways:

• If you are eligible and have enrolled in Medicare Part A, then you are eligible for Medicare Part B too.

• Medicare Part B covers numerous services and preventive care like doctor's visits.

• Eligibility starts three months before you turn age 65, your birth month, and three months after your birth month.

• Because Medicare Part B requires a monthly premium, you could delay enrollment. Just know you may have to pay a late enrollment penalty.

What is Medicare Part B and What Does it Cover?

Medicare Part B is part of Original Medicare (also known as Medicare Part A, which is hospital insurance, and Part B, which is medical insurance) and covers numerous services and preventive care including:

• Doctor's visits

• Tests

• Screenings

• Ambulance transportation

• Some medical supplies and drugs

• Flu and hepatitis vaccinations

• Diabetes supplies

• Some eyeglass prescriptions

Medicare Part B also covers part-time or recurring home health care and rehabilitative services, including physical therapy, if ordered by a doctor.

Some of the preventive services Medicare Part B covers include a one-time preventive visit, flu and hepatitis B shots, cardiovascular, cancer, diabetes screenings and much more.

Check the list of preventive services covered under Medicare Part B to make sure you're well informed.

Am I Eligible for Medicare Part B?

If you are eligible and have enrolled in Medicare Part A, then you are eligible for Medicare Part B too. Even if you're not enrolled in Medicare Part A, you can still qualify for Medicare Part B by meeting the following requirements:

• You must be 65 years or older

• You must be a US citizen, or a permanent resident lawfully residing in the US for at least five continuous years

Also, if you are under 65 and receiving Social Security or Railroad Retirement Board (RRB) disability benefits, you will automatically be enrolled in Medicare Part A and Part B after 24 months of disability benefits. You may also be eligible for Medicare Part B enrollment before 65 if you have end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS) also known as Lou Gehrig's disease.

When Should I Enroll in Medicare Part B?

You can enroll in Medicare Part B as soon as you are eligible. Eligibility starts three months before you turn age 65, your birth month, and ends three months after your birth month. That's a total of seven months that you will have to enroll.

You can also enroll if you're under 65 and disabled, as you will qualify for Medicare automatically after receiving Social Security (or certain disability benefits from the Railroad Retirement Board) for 24 months.

Because Medicare Part B requires a monthly premium and Part A doesn't, some people decide to delay enrollment in Medicare Part B, especially if they have health care coverage through their employer. Should you decide to enroll in Part B later, please remember that you may have to pay a late enrollment penalty for not signing up when you were first eligible.

If you are still working, you should check with your employer's health benefits administrator to see how your insurance would work with Medicare. If you delay enrollment in Medicare Part B because you already have current employer health coverage, you can sign up later during a Special Enrollment Period without paying a late penalty.

You can enroll in Medicare Part B at any time that you are still covered by a group plan based on current employment. After your employer health coverage ends or your employment ends, you have an eight-month special enrollment period to sign up for Medicare Part B without a late penalty.

What Happens if I Don't Enroll in Medicare Part B by the Deadline?

Initial Enrollment Period — If you don't enroll in Medicare Part B during your Initial Enrollment Period, which is three months before your 65th birthday, your birth month, and three months afterward.

General Enrollment Period — If you do not qualify for a special enrollment period, you can also sign up during the annual General Enrollment Period. The General Enrollment period is from January 1 to March 31, with coverage starting July 1. As previously mentioned, you might have to pay a late enrollment penalty for not signing up when you were first eligible.

If you are receiving Social Security benefits and you are not automatically enrolled in Medicare while on Social Security, you can apply for Medicare through Social Security by visiting in person at your local Social Security office. You can also visit the Social Security website, or call 1-800-772-1213 (TTY users 1-800-325-0778) from 7 a.m. to 7 p.m., Monday through Friday.

Are There Other Deadlines I Need to Be Aware of Once I Enroll in Medicare Part B?

Please note once you are 65 years or older and have Medicare Part B, you will have a period of six months to enroll in Medigap. Medigap is extra health insurance you buy from a private company to pay health care costs not covered by Original Medicare (Parts A and B). The extra healthcare costs covered by Medigap insurance include copayments and deductibles, as well as health care if you travel outside the United States.

During this six-month Medigap Open Enrollment Period, you have a guaranteed-issue right to buy any Medigap plan without medical underwriting and without having to pay a higher premium due to a preexisting condition. Once you are enrolled in Medicare Part B, be certain not to miss the Medigap enrollment period because you will have only that one time to take advantage of the initial guaranteed-issue offer.

Sharrarne Morton taught English and journalism in higher education for 16 years and enjoys writing about finance and healthcare.