A Simple Guide to Medicare Part B
Medicare Part B is the portion of Medicare that focuses on medical insurance. It helps cover the costs of many healthcare services you receive outside of a hospital stay.
Part B is designed to cover medically necessary outpatient care. A service is medically necessary when it is required to properly diagnose, manage, or treat a medical condition.
Understanding Medicare Part B Coverage
Medicare is divided into different parts, and Medicare Part A and Part B together make up Original Medicare. As of recent data, more than half of Medicare beneficiaries are enrolled in Original Medicare.
Medicare Part B helps cover a broad range of essential outpatient medical services, including:
-
Ambulance services in emergencies
-
Chemotherapy treatments
-
Durable medical equipment such as wheelchairs, walkers, and oxygen supplies
-
Care received in an emergency room
-
Dialysis treatment for kidney failure
-
Diagnostic lab work, including blood and urine tests
-
Occupational therapy
-
Imaging and diagnostic tests, including echocardiograms
-
Outpatient hospital services, including mental health care
-
Physical therapy
-
Certain organ transplant-related services
Preventive Services Covered by Part B
In addition to treatment services, Medicare Part B also supports preventive care to help detect or avoid serious health conditions. Covered preventive services include:
-
Bone density testing
-
Screenings for cancers such as breast, colorectal, and prostate cancer
-
Cardiovascular health screenings
-
Diabetes testing
-
Screenings for hepatitis B, hepatitis C, and HIV
-
Testing for sexually transmitted infections (STIs)
-
Vaccinations, including flu shots, hepatitis B vaccines, and pneumococcal vaccines
What Does Medicare Part B Not Cover?
While Medicare Part B covers many important medical services, there are certain healthcare expenses it does not pay for. If you need these services, you’ll generally be responsible for covering the costs yourself.
Some common services not included under Part B are:
-
Routine physical checkups
-
Most prescription medications
-
Dental services, including dentures
-
Most vision care, such as eyeglasses and contact lenses
-
Hearing aids and related exams
-
Long-term care (such as extended nursing home stays)
-
Cosmetic or elective surgery
-
Alternative or holistic treatments like massage therapy and acupuncture
Who Can Enroll in Medicare Part B?
Medicare Part B is available to several groups of people, depending on age, health status, and residency.
You may qualify for Part B if you are:
-
Age 65 or older
-
Under 65 and living with a qualifying disability
-
Diagnosed with end-stage renal disease (ESRD), which is permanent kidney failure requiring dialysis or a transplant
Connection Between Part A and Part B
Most people become eligible for premium-free Medicare Part A because they (or their spouse) paid Medicare taxes while working. If you qualify for premium-free Part A, you’re also allowed to enroll in Part B when you first become eligible for Medicare.
If you don’t qualify for free Part A and need to purchase it, you can still sign up for Part B. However, in this case, you must:
-
Be at least 65 years old
-
Live in the United States
-
Be either a U.S. citizen or a lawful permanent resident who has lived in the U.S. continuously for at least five years
Who Needs to Enroll Manually?
Not everyone who qualifies for Original Medicare is automatically enrolled. In some cases, individuals must actively sign up through the Social Security Administration (SSA).
For instance, if you’re approaching age 65 but are not yet receiving retirement benefits from Social Security or the Railroad Retirement Board (RRB), you’ll need to enroll yourself. You can apply as early as three months before your 65th birthday.
Individuals diagnosed with end-stage renal disease (ESRD) are also required to sign up on their own. They can enroll at any time; however, the exact date their coverage begins may depend on their specific situation.
When Are You Allowed to Enroll in Medicare?
There are several specific enrollment periods when you can apply for Medicare coverage. Each period has its own rules and timelines.
Initial Enrollment Period (IEP)
Your first opportunity to sign up is during your Initial Enrollment Period, which lasts for seven months. This window:
-
Starts three months before the month you turn 65
-
Includes your birthday month
-
Ends three months after your birthday month
During this time, you can enroll in any part of Medicare without facing late enrollment penalties.
Open Enrollment Period (October 15 – December 7)
Each year, Medicare offers an Open Enrollment Period. During this timeframe, you can:
-
Switch from Original Medicare (Part A and Part B) to a Medicare Advantage (Part C) plan
-
Change from Medicare Advantage back to Original Medicare
-
Switch between Medicare Advantage plans
-
Add, drop, or change a Part D prescription drug plan
Changes made during this period typically take effect the following year.
General Enrollment Period (January 1 – March 31)
If you missed your Initial Enrollment Period and don’t qualify for a Special Enrollment Period, you can sign up during the General Enrollment Period. However, you may have to pay a late enrollment penalty depending on your situation.
Special Enrollment Period (SEP)
If you postponed enrolling in Medicare due to a qualifying reason, such as having employer-sponsored health coverage, you may be eligible for a Special Enrollment Period.
In most cases, you have eight months from the time your employment ends or your group health coverage stops (whichever comes first) to enroll without paying a penalty.
