Medicare Plan Part B (Medical Insurance)

Medicare Plan Part B is medical insurance to pay for medically necessary services and supplies provided by Medicare. Most people will have to pay a premium to receive this coverage. Part B covers outpatient care, doctor's services, physical or occupational therapists, and additional home health care. While many services and products are covered, Medicare Part B is still not a 100% insurance coverage plan. So, as with any other insurance policy, you should understand the plan and coverage completely upon enrolling.

Medicare Part B will provide additional coverage to help minimize your medical insurance concerns. Whatever health care insurance coverage you choose, make sure you have a clear understanding of options, coverage, and premiums. Seek a Medicare representative that will take time to explain what type of coverage you will receive and will offer clear instructions for signing on with Medicare.

Medicare Part B Helps Pay For:

Doctors' services, outpatient hospital care, and some other medical services that Part A doesn't cover, such as the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary. Get more information about your coverage under Medicare Part B and Medicare Preventive Services that are covered.

A major concern with Medicare Part B coverage is the difference between the cost of medical items or services, particularly physicians' services, and the "reasonable charge" approved by Medicare. When an item or service is determined to be coverable under Medicare, it is reimbursed at 80% of the "reasonable charge" for that item or service, the patient is responsible for the remaining 20%. Unfortunately, the "reasonable charge," a rate set by Medicare, is often substantially less than the actual charge. The result of the "reasonable charge" reimbursement system is that Medicare payment, even for items and services covered by Part B, is often inadequate. That means that you are often left with additional out-of-pocket expenses.

Cost For Medicare Part B:

The premium that you pay for Part B coverage is determined by Medicare. The monthly premium amount is available in the "Medicare & You" handbook produced by the U.S. Centers for Medicare and Medicaid (CMS). Prior to 2006, the Government generally funded about 75 percent of the total Part B premium. Beginning in 2007, higher income beneficiaries began to receive a reduced subsidy which was fully phased in by 2009. At that time, subsidies for higher income beneficiaries will range from about 65 percent to 20 percent of the total premium. This change will affect only about four percent of all Medicare beneficiaries. The Part B premium for 2009 ranges from $96.40 to $308.30, but will be adjusted annually.

Most people pay the Medicare Part B premium per month.  This amount may change periodically. In some cases this amount may be higher if you didn't choose Part B when you first became eligible at age 65. The cost of Part B may go up 10% for each 12-month period that you could have had Part B but did not sign up for it, except in special cases. You probably will have to pay this extra 10% as long as you have Medicare Part B.

Also, your Part B premium may be higher if your income is above a certain level as outlined above. Enrolling in Part B is your personal choice. You can sign up for Part B anytime during a 7-month period that begins 3 months before you turn 65.  If you choose to have Part B, the premium is usually taken out of your monthly Social Security, Railroad Retirement, or Civil Service Retirement payment. If you don't get any of the Railroad or Civil Service Retirement payments, Medicare sends you a bill for your Part B premium every 3 months. You should get your Medicare premium bill by the 10th of each month.