Part B Medical Insurance (Outpatient Services)

What does Part B cover?

Part B covers:

Be aware that each service has its own set of criteria that must be met in order for it to be covered.

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What is NOT covered by Part B?

Part B does NOT cover:

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What are the costs of Part B?

 

 

 

 

 

Premiums:
There is a premium each month, which is based on the beneficiary's income. The amounts may change annually. See Part B Medicare Premiums & Deductibles.
Deductible:
There is an annual deductible. The deductible may change each year. See Part B Medicare Premiums & Deductibles.
Coinsurance:
Medicare generally pays 80 percent of the Medicare-approved cost for a covered service. The patient is then responsible for the remaining 20 percent coinsurance amount or co-payment.
Assignment:

 

One way to save money is to make sure your doctors and providers accept Medicare assignment (the Medicare-approved rate for a given service).  Providers who do not accept assignment may generally charge you up to 15 percent more than the Medicare-approved amount for their services, which you will have to pay in addition to the 20 percent Medicare Part B co-payment.
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What is the Part B Late Enrollment Penalty?

If you do not enroll in Part B when you are first eligible, you will have to wait until the January 1st- March 31st General Enrollment Period (GEP) to do so and your benefits will not begin until the following July.  You will be assessed a 10 percent penalty for each, full 12-month period that you qualified for coverage but did not have it.  The penalty will be added to your monthly premium. 

 

If you qualify for a Special Election Period (SEP), you may be exempt from the penalty.  One common way people qualify for a Special Election Period is if they delayed Part B enrollment due to creditable health coverage based on their own active employment or that of their spouse.  Contact Social Security at 1-800-772-1213 for more detailed information.  See Enrollment Periods/Guaranteed Rights.

 

 

 

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What are Medicare Savings Programs (MSPs)?

Medicare offers several Medicare Savings Programs (MSPs) that assist people with limited income and assets:

  • Qualified Medicare Beneficiary (QMB) - pays for the Medicare Part A and Part B premiums, deductibles, and coinsurance for Medicare beneficiaries who meet the income and asset guidelines.
  • Specified Low-Income Medicare Beneficiary (SLMB) - pays for the Part B premium for Medicare beneficiaries who meet the income and asset guidelines.
  • Qualifying Individual (QI) - pays for the Part B premium for Medicare beneficiaries who meet the income and asset guidelines.
  • Qualified Disabled Working Individual (QDWI) - pays for the Part A premium for people who had Social Security and Medicare benefits due to a disability, but lost them because they returned to work and their earnings exceeded the allowable limit.

These programs are administered by Medi-Cal (California's Medicaid program).  Beneficiaries who are eligible for Medicare Savings Programs (MSPs) also automatically qualify for Low-Income Subsidy (LIS), extra help with their Medicare Part D prescription costs.  For more information or to apply for Medicare Savings Programs, contact HICAP at 1-800-434-0222 for a one-on-one appointment.

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What if I have Amyotrophic Lateral Sclerosis (ALS)?

Patients with Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig's disease, automatically qualify for Medicare Parts A and B the month their Social Security Disability benefits begin.

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What if I have End-Stage Renal Disease (ESRD)?

Patients with End-Stage Renal Disease (ESRD) may sign up for full Medicare four months after their diagnosis.

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