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Effective: December 1, 2013 |
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04.40.10ar8 - Medicare Part B (Archive) |
Archived: December 1, 2014 |
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.
2014 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.
2014 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 2014. There may be additional plans that will also subsidize Medicare Part B premiums.
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Medicare Plan |
Reduction in Part B Premium |
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Blue Plus Secure Blue - MSHO |
No reduction |
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HealthPartners Classic - MSHO |
$10.10 |
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Itasca Medical (IM) Care Classic - MSHO |
No reduction |
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Medica Dual Solutions - MSHO |
No reduction |
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Metropolitan Health Plan - MSHO |
No reduction |
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PrimeWest Senior Health Complete - MSHO |
No reduction |
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South Country Health Alliance SeniorCare Complete - MSHO |
No reduction |
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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.