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 Part B 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.
  • Some 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

Year 2018- $134/month                                                                                                    .                   For Most Medicare Beneficiaries enrolling in Medicare in 2018 the Standard Monthly Premium is $134.00 (new to Medicare Part B. Also, see below Hold Harmless Provision). 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 $133,500
  • Couple: $214,001 to $267,000
$267.90
  • Single: $133,501 to $160,000
  • Couple: $267,001 to $320,000
$348.30
  • Single: $160,001 and over
  • Couple: $320,001 and over
$428.60
 

DEDUCTIBLE

  • In 2018, the Annual Medicare Part B Deductible is $183

COINSURANCE

  • You pay 20% of the Medicare approved amount for doctors’ visits after you meet the $183 (year 2018) deductible.  There is no limit in your spending.  For mental health services you pay 45% of the Medicare-approved amount.
  • 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

  • The standard monthly premium for Medicare Part B enrollees will be $134 for 2018. However, a statutory “hold harmless” provision applies each year to about 70 percent of enrollees. For these enrollees, any increase in Part B premiums must be lower than the increase in their Social Security benefits. After several years of no or very small increases, Social Security benefits will increase by 2.0 percent in 2018 due to the Cost of Living adjustment. Therefore, some beneficiaries who were held harmless against Part B premiums increases in prior years will have a premium increase in 2018.The 30 percent of all Part B enrollees who are not subject to the “hold harmless” provision will pay the full premium of $134 per month in 2018. Part B enrollees who were held harmless in 2016 and 2017 will see an increase in the monthly Part B premium from the roughly $109, on average, they paid in 2017. An estimated 42 percent of all Part B enrollees are subject to the hold harmless provision in 2018 but will pay the full monthly premium of $134, because the increase in their Social Security benefit will be greater than or equal to an increase in their Part B premiums up to the full 2018 amount. About 28 percent of all Part B enrollees are subject to the hold harmless provision in 2018 and will pay less than the full monthly premium of $134, because the increase in their Social Security benefit will not be large enough to cover the full Part B premium increase.Medicare Part B enrollees not subject to the “hold harmless” provision include beneficiaries who do not receive Social Security benefits, those who enroll in Part B for the first time in 2018, 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 percent of total Part B beneficiaries.

There are gaps in coverage concerning Medicare Part B. For this reason many seniors purchase a  Medigap plan to protect against charges Part B does not cover. Questions? Call Allen Heffler in Philadelphia at (215) 658-1776.