Medicare Part B (Archive)

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.

Enrollment.

Coverage.

Premiums.

2012 Medicare Advantage Plans (Part C) that Subsidize Part B Premiums.

Deductibles.

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Enrollment

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.

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Coverage

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.

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Premiums

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.

2012 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 2012. There may be additional plans that will also subsidize Medicare Part B premiums.

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Deductibles

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.

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