Retirement is looming and while you are making amazing plans for what you’ll do after the big day arrives, you may also be feeling some anxiety about expenses and healthcare costs. Switching from an employer-sponsored plan to a new one can be both anxiety inducing and slightly overwhelming.
Most new retirees worry about having to learn a whole new system, having to switch providers and most of all, about how they will pay for medical expenses. Learning more about Medicare can help you select the best healthcare options for your current needs and can give you peace of mind about the process. Once you’ve chosen a plan, you can proceed with confidence and fully enjoy your pending retirement.
Medicare has four basic parts; you may need one or more of them, depending on your overall health and wellness, medication needs and even where you live. Understanding how Medicare works and where each component fits in can help you make an informed decision. As of 2017, there are four major components of the Medicare system.
- Medicare Part A: Coverage for hospitalization
- Medicare Part B: Coverage for doctor’s visits and routine healthcare needs
- Medicare Part C: Also called Medicare Advantage, it can replace Part A and Part B in some locations and situations.
- Medicare Part D: Prescription drug coverage
Medicare Part B is just one of the program options; it is designed to work with Medicare Part A and offers coverage for doctor’s visits, outpatient care and more. This document covers Part B in detail, but it is important to understand where this plan falls into the overall Medicare system to determine if it is the right choice for you. Once you know more about Medicare Part B, you can make an informed choice about whether this plan is right for you.
What is Medicare?
Each year, over 50 million Americans rely on some form of Medicare for health insurance coverage. Most are age 65 or over; on your 65th birthday, you become eligible for coverage under the affordable Medicare program. Medicare Part B is considered “Original Medicare” and pairs with Part A to offer comprehensive coverage for seniors and those with disabilities.
You may choose an initial plan when you turn 65 and then review your options annually. Your health and overall wellness may change from year to year, so regularly reviewing your options can help you make the best possible choice each year. Our easy to read, easy to follow guides are designed to help you understand your options and take an active role in managing your healthcare needs.
“Original Medicare” includes Medicare Part A and Part B; Part B is the subject of this detailed guide and covers your routine healthcare needs. You should know that Medicare Part B is designed to work with Part A; if you choose one, you’ll need the other as well. Everything you need to know about Part A, which covers hospitalization, is covered in our comprehensive guide, located here.
Together, Medicare Parts A and B cover quite a few of your medical costs and needs, but may not cover everything. You’ll still have to cover some costs if you only use Original Medicare. A supplemental plan like the prescription drug insurance offered by Part D may be needed to provide comprehensive coverage.
If you are 65 years of age and a United States citizen, you are eligible to enroll in Medicare Part B. You may be able to enroll if you are under 65 if you have a disability, but anyone 65 or older is accepted, regardless of past medical history. Medicare Part B is a Federal program, so it is available no matter where you live; some of the other Medicare options are only available in specific locations.
What is Medicare Part B?
Medicare Part B is a health insurance plan that covers visits to your doctor for illness, injury or other concerns. It will also cover visits to the hospital that do not require admission; if you have to go to the hospital to get stitches, have an outpatient procedure or a medical test, then Part B will cover it. This Medicare component also covers home health care costs, if the services are medically necessary.
Medicare Part B works the same no matter where you live; you’ll have the same coverage options and rules regardless of your geographic location.
What Hospital or Provider Can I See with Medicare Part B?
If your doctor accepts Medicare, then you can see them under Part B. One of the benefits of choosing Parts A and B is that you can keep going to your existing doctor; other plans may require you to change physicians or practices.
What Does Medicare B Cover?
Medicare Part B covers your routine healthcare needs, from doctor’s visits to outpatient tests and procedures. Unless you stay overnight in the hospital, Medicare Part B will cover your healthcare needs. Even healthy seniors can benefit from Part B, since it covers well care, preventative medicine, medical testing and other services designed to prevent illness or spot signs of trouble early.
Medicare Part B Coverage Examples
Medicare Part B is a comprehensive package that covers many scenarios and expenses, but what does that mean for you if you choose this plan? Any of the following situations would be covered by Medicare Part B once you are enrolled:
- Regular visits to your doctor: Whether you need a routine checkup, suspect you have Strep Throat or even need stitches, Medicare Part B will cover your needs.
- Visits to the hospital for outpatient services: Need to have a medical test or minor procedure at the hospital? Part B will cover your treatment or testing services.
- Emergency room visits: Whether you fell and broke a bone or suddenly felt light-headed, Part B will cover your ER visit. If you are admitted to the hospital, Part A will cover your stay.
- Preventative care: Part B covers some services designed to keep you healthy and feeling your best – if you need a flu shot, Part B will cover it.
- Medical testing: From an MRI to see why your neck hurts to a CAT scan to check out that abdominal pain and even an X-ray after a fall, Part B covers your medical testing needs.
- Lab and bloodwork: If your doctor needs to order bloodwork or other lab services, then these tests are covered under Medicare Part B as well.
- Preventative screenings and services: Some medical screenings and tests are designed to spot trouble early. Tests like mammograms, bone density screenings, PAP tests, diabetes screening and colonoscopies protect your health and keep medical costs low; these tests and others like them are covered by Part B.
- Annual checkup: Stay healthy by visiting your doctor each year for routine bloodwork, vision and hearing screening and other services; this visit is covered by Part B and is free for you.
- Skilled nursing services: Need a specialty nurse or one that provides assistance in a specific area? Medicare Part B will cover it.
- Mental health services: Your mental healthcare needs are covered by Medicare Part B, unless you need to be hospitalized; hospitalization is covered under Part A.
The above items are all covered under Part B, but you will have some healthcare costs. Once your deductible is met, you’ll be responsible for 20% of your costs; a supplemental Medicare plan may be required to cover your costs.
What Fees Are Charged for Medicare Part B?
When you choose Medicare Part B for your coverage, you’ll have the following costs:
- Monthly Insurance Premiums: You’ll make a contribution each month for Medicare Part B. The amount of your monthly premium is based on your income, so it will vary from person to person. In 2017, monthly premiums for Medicare Part B range from $134 to $428.60.
- Deductibles: Medicare Part B has a deductible of $183 per year in 2017.
- Costs: After your deductible is met, Medicare Part B will cover 80% of your medical costs for covered items and visits. You’ll be responsible for paying the other 20%.
Medicare Part B Does Not Cover:
There are some things that Medicare Part B does not cover you for, including:
- Overnight stays in the hospital (this is covered by Part A)
- Prescription Medication (this is covered by optional plan Part D)
- Dental Care
- Eyeglass appointments (medical treatment for eye and vision related issues is covered, but appointments for glasses or contacts are not)
- Acupuncture and alternative medicine
- Chiropractic care
- Hearing aids
- Foot care
When Can You Enroll in Medicare Part B?
Your Initial Enrollment Period (IEP) is your first opportunity to sign up for Medicare Part B. If you are already receiving Social Security, then enrollment will happen automatically; if not, you’ll need to sign up during the IEP.
Your IEP will depend on your birthday. The three months before your birthday month, your actual birthday month and the three months after your birthday month make up your Initial Enrollment Period for Medicare Part B. If you turn 65 in June, then your IEP would run from March to September of that year.
While you have several months to enroll, signing up before your birthday ensures your coverage is in place when you need it.
Review your Medicare Enrollment Options Annually
Once you’ve enrolled in Medicare, you’ll need to review your options each year to make sure the plan you’ve chosen still suits your needs. The coverage you initially choose may not be enough if your needs change; a single costly prescription could drive your expenses up; adding a supplemental plan can help offset this expense.
If you want to make changes to your Medicare enrollment after you’ve chosen Part B, you need to do so during a set time period. Each year, open enrollment runs from October 15th to December 7th; you can make changes to your Medicare plan during this time.
Is it Time to Learn About Medicare?
Worried about your healthcare options? The best time to learn more is before you turn 65; if you are already considering your retirement options, then Medicare should be part of the conversation. Learning more about what Medicare covers, what it costs and what to expect will help you make the best possible choices for yourself, your spouse or even a senior parent.
Make an Informed Choice
Understanding how Part B works, what it covers and what it does not can help you make the best possible choice. This Medicare program is available to you no matter where you live and you can’t be turned down, so your primary considerations should be cost and what components you need in your healthcare insurance. Since the plan you choose will impact your finances and budget during retirement, incorporating Medicare into your planning can help you make the most of this exciting time and give you the peace of mind you need to move forward with your plans.