*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016. Please refer to the EPM for current health care program policy information. ***
Effective: December 1, 2014 |
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04.40.10 - Medicare Part B |
Archived: June 1, 2016 (Previous Versions) |
Medicare Part B is medical insurance. This section provides general information about Medicare Part B enrollment and coverage. For more information about Medicare Part B, see the Medicare Web site.
2015 Medicare Advantage Plans (Part C) that Subsidize Part B Premiums.
People who are newly entitled to premium-free Medicare Part A are automatically enrolled in Medicare Part B unless they decline the coverage during their initial enrollment period.
People, who do not have enough work credits to qualify for premium-free Medicare Part A, must file a written request with the Social Security Administration (SSA) to enroll in both Parts A and B during their initial enrollment period or a general enrollment period.
People who decline Medicare Part B and then later wish to enroll will pay an increased premium due to late enrollment. They may enroll in Part B during the next general enrollment period.
Exceptions:
n People who enroll in Medicare through a Medicare Savings Program or through the buy-in do not have to wait until the general enrollment period to start Medicare Part A or Part B. These programs initiate special enrollment. They also will not pay an increased premium for late enrollment while they are on a Medicare Savings Program or the buy-in.
n People who have group health insurance through their own or a spouse’s employment may choose to wait to sign up for Part B without paying an increased premium for late enrollment. They can sign up for Part B any time while the group health insurance is in place or during the eight-month period that begins when the employment ends or the group insurance coverage ends, whichever happens first.
See Medicare Savings Programs (MSP) and The Buy-In for more information about these programs.
See Medicare for more information about a Medicare beneficiary’s initial enrollment period and the general enrollment period.
Medicare Part B helps cover the following when they are medically necessary:
l Doctors’ services.
l Outpatient care.
n An initial physical exam for new Medicare beneficiaries.
n Diabetes and cardiovascular screening tests.
n Certain limited prescription drugs, such as injected drugs given in a doctor’s office.
l X-rays.
l Laboratory services.
l Certain medical supplies, also known as Durable Medical Equipment (DME).
l Medical services not covered by Part A, such as certain services of physical and occupational therapists, or home health care.
l Certain preventative services and tests such as flu shots, mammograms, and colorectal cancer screenings.
In general, the following services are not covered, although there may be exceptions depending on a person’s medical status or what type of Medicare plan is chosen:
l Cosmetic surgery.
l Dental.
l Acupuncture.
l Hearing aids.
l Routine eye care.
There is a monthly premium for Part B. Historically, most people on Medicare paid the same premium amount for Part B coverage. However, beginning in 2010, people new to Medicare will pay a higher premium for Part B than many of those who were already active on Medicare in 2009. Additionally, since 2007, there are higher Part B premiums on a sliding-scale for people at certain higher income levels. See Medicare Cost-Sharing Amounts for the Part B premium amounts.
The Part B premium may be increased for people who failed to enroll in Medicare Part B when they first qualified for coverage or who reenroll after canceling their Part B coverage. The increase is 10% for every year the beneficiary failed to enroll in Part B and did not have other employer group health insurance.
People who enroll in Part B through a Medicare Savings Program or the buy-in do not pay increased premiums for late enrollment.
Federal law was enacted in 2003 that allows Medicare Advantage plans (Part C) to subsidize the Medicare Part B premiums for their members. This means that MA enrollees in certain Medicare Advantage plans may pay reduced Part B premiums. Reduced Part B premiums can be viewed in MMIS on the RBYB screen if the enrollee is on a Medicare Savings Program or the buy-in. The State pays the reduced Part B premium.
When calculating MA eligibility for applicants or enrollees not participating in a Medicare Savings Program or the buy-in, only the amount the person actually pays for Medicare Part B can apply toward a spenddown, waiver obligation, or be reimbursed as a cost effective premium.
Note: MA will pay the higher 2010 Part B premium amount for people enrolled in a Medicare Savings Program or the buy-in, even though the Medicare beneficiary may pay a lower amount in 2010 if payment was withheld from Social Security benefits.
2015 Medicare Advantage Plans (Part C) that Subsidize Part B Premiums
DHS has confirmed the following Medicare Advantage plans will subsidize Medicare Part B premiums in 2015. There may be additional plans that will also subsidize Medicare Part B premiums.
Medicare Plan |
Reduction in Part B Premium |
Blue Plus Secure Blue - MSHO |
No reduction |
HealthPartners Classic - MSHO |
$9.50 |
Itasca Medical (IM) Care Classic - MSHO |
No reduction |
Medica Dual Solutions - MSHO |
No reduction |
PrimeWest Senior Health Complete - MSHO |
No reduction |
South Country Health Alliance SeniorCare Complete - MSHO |
No reduction |
UCare - MSHO/SNBC |
No reduction |
Part B has an annual deductible that must be incurred by the person before Medicare will begin to pay services. See Medicare Cost-Sharing Amounts for the Part B deductible amounts.