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Medicare Part B coverage overview

Medicare Part B provides medical insurance to senior citizens older than age 65 as well as to individuals with certain disabilities. It covers outpatient care such as doctor visits, medical equipment and certain preventive services. Together with Part A, Part B makes up what is known as original Medicare.

Premiums for Medicare Part B

Unlike Medicare Part A, which is free for many people, all beneficiaries pay a premium for their Part B coverage. Most individuals pay a standard premium rate. In 2012, this standard premium is $99.90 per month.

Individuals with higher incomes may be required to pay higher premiums. In 2012, the higher premiums applied to individuals with annual modified gross adjusted incomes exceeding $85,000 for a single taxpayer or $170,000 for those filing jointly. According to the Social Security Administration, less than 5 percent of all Medicare beneficiaries have incomes above these amounts and pay the higher Part B premiums.

How to apply for Medicare Part B

Enrollment for Medicare Part B is the same as for Part A. Individuals who receive disability benefits from the Railroad Retirement Board or Social Security are automatically enrolled in Part B. Coverage begins when they turn 65 or 24 months after the start of disability benefits, whichever comes first. However, individuals diagnosed with ALS, commonly called Lou Gehrig's disease, can begin receiving their Medicare Part B coverage immediately upon approval for disability payments.

Individuals who are not automatically enrolled in Medicare Part B must apply through the Social Security Administration. Individuals may apply on the administration's website or by calling 1-800-722-1213. Applications are also accepted in person at Social Security offices.

For senior citizens, the initial enrollment period for Medicare Part B starts three months before an individual's 65th birthday, includes the birthday month and continues for three months after the birthday month. The Health and Human Services Department recommends seniors apply in the three months before their birthday to ensure there is no delay in receiving benefits.

In addition to the initial enrollment period, there is a general enrollment period from January 1st to March 31st of each year. Senior citizens can apply for Part B coverage during this time but may pay higher premiums than those who started their coverage during the initial enrollment period.

What does Medicare Part B cover?

Services covered under Medicare Part B can be separated into two categories: medically-necessary services and preventive services. Medically-necessary services exclude inpatient care, which is covered by Part A, but include many other health care needs, including the following:

  • Doctor visits
  • Outpatient care
  • Durable medical equipment
  • Home health services

During the first 12 months of Part B coverage, a beneficiary is entitled to a free "Welcome to Medicare" preventive visit. During this visit, a health care provider evaluates a beneficiary's health and wellness as well as identifies necessary preventive services. After 12 months of enrollment in Part B, beneficiaries are entitled to a yearly wellness visit free of charge.

Other preventive services covered by Medicare Part B include certain cancer screenings, immunizations and tobacco use cessation counseling. Deductibles and copays may apply to certain services. For an extensive list of services covered by Medicare Part B, refer to Medicare and You, published by the Centers for Medicare and Medicaid Services.

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