Medicare Part B

Medicare Part B is a Medical Insurance portion of Original Medicare. It is optional. Original Medicare allows you to use ANY doctor, specialist, or hospital that accepts Medicare. There is no network of doctors that you have to adhere to and you never need a referral. You are paying a separate amount for each service – fee for service.

ELIGIBILITY You are eligible for Medicare if:

  • you are 65 years or older, and
  • you are a citizen or permanent resident of the United States who has lived in US for at least 5 years
  • If you are not yet 65, you might also qualify for coverage if you have a disability or End-Stage Renal disease (permanent kidney failure requiring dialysis or transplant).  You are entitled for Medicare after you get disability benefits from Social Security for 24 months.
  • Your age is the main determining factor. You do NOT need to retire or receive Social Security benefits in order to be eligible for Medicare.
  • Many Medicare beneficiaries are dual-eligible, i.e. they are qualified for both Medicare and Medicaid.

BENEFITS

Medicare Part B covers a portion of:
  • Doctors’ services
  • Outpatient hospital care
  • Laboratory tests
  • Outpatient physical therapy
  • Outpatient speech therapy
  • Certain home health care
  • Certain ambulance services
  • Certain medical equipment and supplies
  • (above list of benefits is not all inclusive)

PREMIUM for Part B

For Most Medicare Beneficiaries enrolling in Medicare in 2017: Standard Monthly Premium is $134.00 (new to Medicare Part B). Those with a higher income pay a higher Medicare Part B premium. Your Annual Income & Your Monthly Premium*
  • Single: up to $85,000
  • Couple: up to $170,000
$134.00
  • Single: $85,001 to $107,000
  • Couple: $170,001 to $214,000
$187.50
  • Single: $107,001 to $160,000
  • Couple: $214,001 to $320,000
$267.90
  • Single: $160,001 to $214,000
  • Couple: $320,001 to $428,000
$348.30
  • Single: $214,001 and over
  • Couple: $428,001 and over
$428.60

DEDUCTIBLE

  • In 2017, the annual Part B deductible is $183

COINSURANCE

  • You pay 20% of the Medicare approved amount for doctors’ visits after you meet the $183 (year 2017) deductible.  There is no limit in your spending.  For mental health services you pay 45% of the Medicare-approved amount.
  • Beginning 2011, beneficiaries will have no cost-sharing for most preventive services.
EXCESS CHARGES
  • For services rendered by non-participating providers (non-participating providers haven’t signed an agreement to accept assignment for all Medicare-covered services, but they can still choose to accept assignment for individual services) a physician may charge a maximum of 115% of the Medicare approved amount.  This 15% overcharge is known as Excess Charges, and you are responsible for them.  This is NOT applicable for Pennsylvania, because in Pennsylvania you cannot charge more than the Medicare approved amount.  This is known as Medicare Overcharge Measure law (MOM).
 

 Hold Harmless Provision

  • Medicare Part B beneficiaries NOT subject to the “hold harmless” provision include beneficiaries who do not receive Social Security benefits, those who enroll in Medicare Part B for the first time in 2017, those who are directly billed for their Part B premium, those who are dually eligible for Medicaid and have their premium paid by state Medicaid agencies and those who pay an income-related premium. These groups represent approximately 30% of total Part B beneficiaries.