Difference between part a and part b medicare

Original Medicare coverage consists of two parts. While Medicare Part A is inpatient hospital coverage, Medicare Part B covers outpatient coverage for various medical services and doctor appointments.

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What is Medicare Part B?

Medicare Part B is the part of Original Medicare that covers doctors’ visits, outpatient care, and durable medical equipment. Medicare part B covers preventative and medically necessary services that you receive under the supervision of a Medicare-accepting physician.

Once you enroll in Medicare Part B, you become eligible to enroll in a Medicare Supplement plan or a Medicare Advantage plan.

Medicare Supplement plans help cover the costs left behind by Original Medicare. Since you are not covered at 100% by Original Medicare, these Medicare Supplement plans help you create individualized full coverage benefits while still utilizing Original Medicare benefits. Medicare Supplement plans can cover the Medicare Part B coinsurance, so you are not left covering this out-of-pocket cost.

Medicare Part B Eligibility

To enroll in Medicare Part B, you must meet specific criteria by the Center for Medicare and Medicaid Services (CMS).

If you receive Medicare Part A, you are eligible for Medicare Part B by enrolling and paying the monthly premium.

However, if you are new to Medicare, you must meet the following criteria:

• Must be a U.S. citizen for at least five years

AND one of the following

• Age 65 or older
• Under 65 and receiving Social Security disability benefits for at least 24 months
• Diagnosed with Amyotrophic Lateral Sclerosis
• Diagnosed with End-Stage Renal Disease

You can enroll in Medicare Part B if you meet the above requirements.

What is Covered by Medicare Part B

Medicare Part B offers comprehensive coverage for outpatient services, durable medical equipment, and doctor visits. The two main types of coverage this part of Medicare includes are medically necessary and preventive.

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The medically necessary coverage encompasses a variety of tests, procedures, and care options. A medical service or supply must be a requirement for treating or diagnosing a medical condition for Medicare to consider them medically necessary. Each situation is different, so a medical supply or medically necessary service for one person may not be for another.

It is easy to keep up with your general health needs through Medicare’s outpatient insurance by utilizing annual wellness visits.

Medicare Part B covers the following preventive care services:

• Vaccines 
• Annual Cancer Screenings 
• Lab Work 
• Mental Health Counseling 

You can receive many preventive services and more at your annual wellness visit.

Alongside preventive care services, Medicare Part B covers certain outpatient services you receive in the hospital. These include:

• Surgeries
• Diagnostic imaging
• Chemotherapy
• Dialysis

If you are given drugs while at the hospital, Medicare Part B will also provide coverage for these services.

What Does Medicare Part B Not Cover?

Medicare Part B only covers specific services performed by medical professionals who accept Original Medicare Coverage.

Medicare Part B does not cover:

• Dental
• Vision
• Hearing
• Prescription drug coverage

Further, it does not cover anything not considered medically necessary or preventive, nor any medical services provided by non-Medicare-participating providers. Finally, all inpatient services are covered under Medicare Part A coverage.

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What is the Difference Between Medicare Part A and Medicare Part B?

Medicare Part A and Medicare Part B are the two parts of Medicare that make up Original Medicare coverage. For most, Original Medicare is your primary healthcare coverage once you reach age 65 or receive disability income.

Medicare Part A handles inpatient services and benefits, whereas Medicare Part B covers outpatient, doctor, and medical supply benefits.

The two coverages work hand in hand but are not the same in terms of cost and benefits. Often, you will not need to pay a premium for Medicare Part A. However, you will need to pay a monthly premium for Medicare Part B. Regarding out-of-pocket costs, both parts of Medicare require you to pay deductibles, coinsurance, and copayments. However, those costs look very different between the two parts.

How Much Does Medicare Part B Cost?

When you enroll in this part of Medicare, you are responsible for its costs such as premiums. In 2023, the standard Medicare Part B premium is $164.90 each month.

However, those in a higher income bracket will pay a higher monthly premium. This higher monthly premium is due to the Income Related Monthly Adjustment Amount (IRMAA). IRMAA is calculated by looking at your annual income and using a sliding scale to determine your premium.

Most people on Medicare will have their premium automatically deducted from their monthly Social Security benefits check. If you do not receive Social Security benefits, you will get a quarterly bill from Medicare.

Medicare offers an online payment option called Easy Pay, which you can access with a MyMedicare account. Additionally, you may pay your quarterly premium by mail instead.

Alongside the premium, your Medicare Part B coverage includes an annual deductible and 20% coinsurance, for which you are responsible for paying out-of-pocket. In 2023, the Medicare Part B deductible is $226.

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Once you meet the annual deductible, Medicare will cover 80% of your Medicare Part B expenses. If you want to lower your Medicare Part B costs, Medicare Supplement plans can close this coverage gap. Medicare Supplement plans help reduce other out-of-pocket costs and is accepted anywhere Original Medicare is accepted.

If you are a lower-income beneficiary and are dual-eligible for both Medicare and Medicaid, you may qualify for a Medicare Savings Program.

Medicare Savings programs pay all or most of your Medicare Part B premium. Also, some Medicare Advantage plans will reduce the monthly premium cost through a give-back benefit.

How Do I Apply for Medicare Part B?

Beneficiaries collecting Social Security benefits when they age into Medicare at 65 will automatically enroll. If this is the case for you, you will receive your Medicare card one to three months before your 65th birthday. You must register yourself if you are not collecting Social Security benefits. You can apply for Medicare Part B online, over the phone, or in person.

All beneficiaries will have an Initial Enrollment Period for Original Medicare. Your Initial Enrollment Period begins three months before your 65th birth month and ends three months after you turn 65. If you do not enroll during your Initial Enrollment Period and do not have creditable coverage, you could be subject to a penalty when you decide to enroll.

Can I enroll in Medicare Part B at Any Time?

To enroll in Medicare Part B you must have a valid enrollment period.

When you first become eligible for Medicare, you will have an Initial Enrollment Period. If you do not enroll during this time, you must wait until the General Enrollment Period to enroll in coverage. The only exception to this is if you qualify for a Special Enrollment Period.

If you qualify for a Special Enrollment Period, you receive an individualized time to enroll in Medicare Part B without penalty based on a special circumstance. It is essential to utilize these opportunities if you have the chance. If you do not have a Special Enrollment Period, you may be required to pay a Medicare Part D late enrollment penalty.

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Medicare Part B FAQs

How long does it take to get Medicare Part B after applying?

Approval can take up to 30-60 days if you apply outside your Initial Enrollment Period and do not automatically enroll in Medicare.

Am I required to pay the Medicare Part B deductible upfront?

No, your doctor will need to bill Medicare first. Then, Medicare will bill you for the deductible.

Do you pay the Medicare Part B premium with Medicare Advantage?

Yes, you still must pay any applicable Original Medicare premiums when you have a Medicare Advantage Plan.

Do I have to pay for Medicare Part B if I have other insurance?

Depending on your insurance, you may be able to delay without penalty.

Does Medicare Part B cover glasses?

No, Medicare Part B will not cover the cost of glasses. Some Medicare Advantage plans may provide some benefits for glasses.

Is Medicare Part B eligibility based on income?

No, eligibility for Original Medicare is not based on income. It depends on your age or disability status.

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