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Do I Need Medicare Part B?

Is Medicare Part B optional? Yes, because some people still working may wish to delay it until they retire.

Enrolling in Part B when Medicare is primary will help you avoid unexpected medical bills.

It is a critical component of your overall health package when Medicare is primary.


medicare part b

What does Medicare Part B cover?

what does medicare part b coverMedicare part b is your outpatient coverage.

Once you stop working and retire and no longer have no access to other health coverage, Medicare becomes your primary insurance. Part A will pay for your room and board in the hospital. Part B covers most of the rest.

Enrolling in Part B when Medicare is primary will help you avoid unexpected medical bills. The Medicare definition for Part B is “outpatient coverage.” Although, Part B covers several things in and out of the hospital. Part B will provide 80% coverage for doctor visits, lab work, physical therapy, medical equipment, diabetes supplies, surgeries, chemotherapy, radiation, dialysis, and more.

Is Medicare Part B optional? Yes, because working people may want to delay it until they are ready to retire.

However, it is critical to your overall health package when Medicare is primary.

Some situations where Medicare is the primary insurance:

  • When you are 65 or older and have employer coverage at a company with less than 20 employees
  • When you are under 65 on Medicare due to disability and work for an employer with less than 100 employees
  • If you have retiree coverage from a former employer
  • With COBRA insurance, you must enroll in Part B by the 8th month of COBRA
  • When you are turning 65 with Tricare for Life (TFL) or CHAMPVA
  • When you are 65 or older and enrolled in Medicaid

All these situations require you to be enrolled in Part B. Without it, you would be responsible for the first 80% of all outpatient charges. Even worse, your secondary coverage may not pay if you are not actively enrolled in Part B as your primary coverage.

Employer coverage, retiree coverage, COBRA, TFL, and Medicaid are your secondary insurance, but only if you take care of your part and enroll in Part B first. Failing to enroll in Part B means you will also owe a penalty if you decide to enroll later.


Do I need Medicare Part B if I have other insurance?

Suppose you already have insurance coverage through your employer or other sources. In that case, you may wonder if you need to enroll in Medicare Part B. After all, why pay for additional coverage if you’re already adequately insured? In this article, we’ll examine whether it’s necessary to have Medicare Part B if you have other insurance.

Medicare Part B covers many medical services, including doctors’ visits, outpatient care, medical supplies, and preventive services. While enrolling in Part B is not mandatory, some critical factors must be considered. Some employer plans may require you to enroll once you become eligible, while others may provide coverage comparable to or better than what Medicare offers. Additionally, delaying enrollment in Part B can result in late enrollment penalties and gaps in coverage.

Understanding your options and making an informed decision is crucial to ensure you have the right coverage for your healthcare needs. In the following sections, we’ll delve deeper into the considerations for individuals with other insurance and how it interacts with Medicare Part B.

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Do I still need Medicare Part B if I’m still working

Suppose you are still working and have employer insurance. In that case, you may question whether you must enroll in Medicare Part B. If you have comprehensive coverage through your employer, it’s natural to wonder if Medicare is necessary.

While the decision ultimately depends on your specific circumstances, a few key factors must be considered. One important consideration is the size of your employer, as mentioned earlier. If you work for a small employer with fewer than 20 employees, Medicare typically becomes the primary payer once you become eligible. In this case, enrolling in Part B would be necessary to ensure comprehensive coverage. However, if you work for a more significant employer with 20 or more employees, your employer insurance would likely remain the primary payer, and you may have more flexibility in deciding whether to enroll in Part B.

Another factor to consider is the cost of Medicare Part B. Part B has a monthly premium, and evaluating whether the additional cost is worth the benefits is essential. If your employer insurance offers comprehensive coverage and you rarely visit doctors or require outpatient care, you may decide that the cost of Part B is unnecessary.

It’s also worth noting that delaying enrollment in Part B can result in late enrollment penalties. If you don’t enroll in Part B when you’re first eligible and don’t have other creditable coverage, you may face a permanent increase in your Part B premium. This penalty is calculated based on the months you were eligible for but still need to enroll. Therefore, if you anticipate needing Part B in the future, enrolling when you’re first eligible may be wise to avoid potential penalties.

Ultimately, deciding whether to enroll in Medicare Part B while still working depends on factors such as the size of your employer, the comprehensiveness of your employer insurance, your healthcare needs, and the potential cost of Part B. It’s important to carefully evaluate your options and seek guidance from a healthcare professional or Medicare advisor.

Medicare Part B enrollment

medicare part b enrollmentSigning up when you first become eligible for:

  • Part A (Hospital)
  • Part B (Medical)

Generally, you first become eligible to sign up for Medicare Part A and Part B, starting 3 months before age 65 and ending 3 months after you turn 65.

Medicare Part B penalty

If you miss and don’t sign up when you first become eligible, you’ll have to wait to sign up and go months without this important coverage. You may also have to pay a monthly penalty for as long as you have Part B. The penalty only gets higher the longer you wait on signing up. How much is the Part B penalty? 

Medicare Part B irmaa

What is IRMAA? IRMAA is a surcharge that people with income above a certain amount must pay in addition to their Medicare Part B and Part D premiums. The Social Security Administration (SSA) determines who pays an IRMAA based on the income reported 2 years prior.

What else do I need to know?

  • Medicare helps cover your costs for health care, like hospital visits and doctors’ services.
  • Most people don’t pay a premium for Part A, but you pay a monthly premium for Part B.
  • Get a quick view of costs. 
  • If you can’t afford the monthly premium, there are programs to help lower your costs. Get details about cost-saving programs.

Do I need Medicare Part B if I have Medicaid?

If you have Medicaid, a government program that provides healthcare coverage for low-income individuals, you may wonder if you still need to enroll in Medicare Part B. Medicaid and Medicare are separate programs. Their interaction can vary depending on your specific circumstances.

In most cases, individuals who are dually eligible for Medicare and Medicaid (“dual eligibles”) are automatically enrolled in Part B. This is because Medicaid helps cover the costs of Medicare premiums, including Part B. If you’re eligible for both programs, registering in Part B can provide additional coverage and access to a broader network of healthcare providers.

Medicaid coverage can vary from state to state, and some states may provide benefits comparable to or better than what Medicare offers. Enrolling in Part B may not be necessary if your Medicaid coverage adequately meets your healthcare needs. However, it’s essential to carefully review the terms of your Medicaid coverage and consider the potential advantages and disadvantages of enrolling in Part B.

One important consideration is that Medicaid may not cover all Medicare Part B’s services. Medicare Part B covers many medical services, including doctor visits, outpatient care, preventive services, and medical supplies. If your Medicaid coverage is limited in these areas, enrolling in Part B can help ensure comprehensive coverage.

It’s also worth noting that if you’re eligible for Medicare and Medicaid but choose not to enroll in Part B, you may face late enrollment penalties if you decide to enroll later. Therefore, carefully consider your options and consult with a healthcare professional or Medicaid advisor to make an informed decision.

How to sign up for Medicare Part B

medicare part b formSign up for Part B

  • What’s the form called?
  • Application for Medicare part b Enrollment form (CMS-40B)
  • What’s it used for?
  • Signing up for Part B when you already have Part A.

Give proof of employment when you sign up for Part B

  • What’s the form called?
  • Request for Employment Information (CMS-L564)
  • What’s it used for?
  • Giving the Social Security Administration proof you’re eligible to sign up for Part B using a Special Enrollment Period for one of these reasons:
    • You’re still working.
    • You retired within the last 8 months.
    • You lost job-based health coverage within the last 8 months.

Source: https://www.cms.gov/cms40b-application-enrollment-part-b

Can I drop my employer’s health insurance and go on Medicare?

If you have employer health insurance and are considering dropping it in favor of Medicare, there are a few essential factors to consider. Medicare and employer insurance can provide different benefits and costs, so evaluating your options and making an informed decision is crucial.

One key consideration is the comprehensiveness of your employer insurance. Some employer plans may offer coverage comparable to or better than what Medicare provides. If your employer plan meets your healthcare needs and provides comprehensive coverage, you may keep it and delay enrolling in Medicare Part B.

However, if your employer insurance is limited in coverage or you anticipate needing services not covered by your employer plan, enrolling in Part B may be beneficial. Medicare Part B covers many medical services, including doctor visits, outpatient care, preventive services, and medical supplies. Having Part B can provide you with additional coverage and access to a more extensive network of healthcare providers.

Another essential factor to consider is the cost of Medicare Part B compared to your employer’s insurance premiums. Medicare Part B has a monthly premium, and it’s essential to evaluate whether the price is worth the benefits provided. If Part B costs significantly less than your employer’s insurance premiums and offers comparable or better coverage, you may switch to Medicare.

It’s worth noting that if you drop your employer insurance and enroll in Medicare, you may be unable to rejoin your employer plan. Therefore, carefully evaluate your options and consider your long-term healthcare needs.

In summary, whether to drop your employer health insurance and go on Medicare depends on factors such as the comprehensiveness of your employer plan, your healthcare needs, and the cost of Medicare Part B. It’s essential to evaluate your options carefully, consider seeking guidance from a healthcare professional or Medicare advisor, and make an informed decision that best meets

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Can I get Medicare Part B for free?

can i get medicare part b for freeMedicare Part A – which covers the hospital care – is free for most enrollees, and Part B – which covers doctor visits, diagnostics, and preventive care – charges participants a premium. The premium for medicare part b burdens many seniors, but here’s how you can pay less for them.

  • Medicare Part B is very rarely “free”; there are monthly premiums most people have to pay for their Medicare Part B coverage.
  • Several programs can help to reduce the cost of your Medicare Part B premium and even cover the cost entirely.
  • The three cost reduction programs are the Qualified Medicare Beneficiary (QMB), the Specified Low-Income Medicare Beneficiary(SLMB), and Qualifying Individual (QI)
  • The standard Part B premium for 2015 was $121.80, although it can be higher based on your income or other factors.

Social Security Medicare Part B eligibility

social security medicare part bMedicare and Social Security are federal programs for Americans that are no longer working. Both programs help people who have reached retirement age or have a chronic disability.

Social Security provides financial support through monthly payments, while Medicare provides health insurance. The qualifications for both programs are similar. If you are receiving Social Security benefits, it is the one way that you should be enrolled automatically in Medicare once you become eligible.

  • Medicare and Social Security are federally managed benefits you’re entitled to based on your age, the number of years you have paid into the system, or if you have a qualifying disability.
  • If you’re receiving Social Security benefits, you’ll automatically enroll in Medicare once you’re eligible.
  • Medicare premiums can be deducted from your Social Security benefit payment.

How do Medicare and Social Security work together?

You’ll get Medicare automatically if you’re already receiving Social Security retirement or SSDI benefits. For example, if you took retirement benefits starting at age 62, you’ll be enrolled in Medicare three months before your 65th birthday. You’ll also be automatically registered once receiving SSDI for 24 months.

You’ll need to enroll in Medicare if you turn 65 but haven’t taken your Social Security benefits yet. The Social Security Administration (SSA) and Medicare will send you a “Welcome to Medicare” packet when you’re eligible to enroll. The packet will walk you through your Medicare choices and help you enroll.

SSA will also determine the amount you need to pay for Medicare coverage. You won’t pay premiums for Part A unless you don’t meet the coverage rules discussed above, but most people will pay a premium for Part B.

What medicare part a covers

medicare part aMedicare Part A is mainly hospital insurance. For coverage of doctor visits, medical services, and supplies, see Medicare Part B.

Part A helps cover the services listed below when medically necessary and delivered by a Medicare-assigned healthcare provider in a Medicare-approved facility. For more cost information, read about Medicare costs.

Blood transfusions

In most cases, the hospital gets blood from a blood bank at no charge, so if you receive blood as part of your inpatient stay, you won’t have to pay for it or replace it. If the facility has to buy blood for you, usually, you need to pay for the first three units you get in a calendar year or have it donated. Medicare Part A covers the cost of blood beyond the first three units you receive during a covered stay in a hospital, critical access hospital, or a skilled nursing facility.

Hospital stays

Medicare Part A covers hospital stays, including a semi-private room, meals, general nursing, and certain hospital services and supplies. Part A may cover inpatient care in:

  • Critical access hospitals
  • Inpatient rehabilitation facilities
  • Acute care hospitals
  • Qualifying clinical research studies
  • Long-term care hospitals
  • Psychiatric hospitals (up to a 190-day lifetime maximum)

Medicare Part A covers this care if all of the following are true:

  • A doctor orders medically necessary inpatient care for at least two nights (counted as midnights).
  • The facility accepts Medicare and admits you as an inpatient.
  • You require care that can only be given in a hospital.
  • The hospital’s Utilization Review Committee approves your stay.

Nursing home or skilled nursing facility

Medicare Part A covers limited care in a skilled nursing facility (SNF) if your situation meets some criteria:

  • You’ve had a “qualifying inpatient hospital stay” of at least three days (72 hours). The time begins the first midnight after admission and does not include any hours on the discharge date.
  • The SNF is Medicare-certified.
  • Your doctor has determined you need skilled nursing care every day. This care must come from (or be directly supervised by) skilled nursing or therapy staff.
  • You haven’t used all the days in your benefit period. (According to Medicare, this period begins the day you’re admitted to an SNF or a hospital as an inpatient and ends when you haven’t had inpatient care or skilled nursing care for 60 consecutive days.)
  • You require skilled nursing services either for a hospital-related medical condition or a health condition that started when you were getting SNF care for a hospital-related medical condition.

Nursing home or skilled nursing facility stays must be related to your diagnosis during a hospital stay. For instance, suppose your hospital stay was for a stroke, and your doctor determined that a nursing home or skilled nursing facility was medically necessary for your recovery. In that case, Medicare may cover nursing home or qualified nursing facility stay for rehabilitation. A nursing home or skilled nursing facility stay includes a semi-private room, meals, and rehabilitative and professional nursing services and care.

The coverage is limited to 100 days in a benefit period. The first 20 days are paid in full, and the remaining 80 days will require a copayment. Medicare Part A will not cover long-term care, non-skilled, daily living, or custodial activities.

Swing beds

Certain hospitals and critical access hospitals have agreements with the Department of Health & Human Services that let the hospital “swing” its beds into (and out of) SNF care as needed. The same cost-sharing and coverage rules apply if these services were delivered in an SNF.

Home health services

Eligible home health services may include limited part-time care with intermittent skilled nursing care, physical or continued occupational therapy, home health aide service, speech-language pathology, and more. It may also include necessary in-home medical equipment (wheelchairs, hospital beds, walkers, oxygen) and other medical supplies.

Hospice care

Hospice care is for the terminally ill, who are expected to have six months or less to live. Coverage includes pain-relief and symptom-control prescription drugs, medical and support services, grief counseling, and other services. Care is provided by a Medicare-approved hospice provider who will visit you at your home. Medicare also provides additional care for a hospice patient so that the usual caregiver can take a time of rest. Medicare may not cover all services provided to patients receiving hospice assistance.

Whatever health care insurance coverage you choose, make sure you have a clear understanding of all the options, coverage, and premiums. Don’t be afraid to ask questions and seek a Medicare representative that can help you to fully understand and tell you what you will need to do to sign up.

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What is the medicare deductible?


Medicare deductible: Part A

medicare deductibleMedicare Part A benefits include inpatient hospital care, skilled nursing facility care, home health services, and hospice.

You usually have to pay the Part A hospital inpatient deductible for a hospital stay, which is $1,556 in 2022 for each benefit period. That’s not an annual deductible. A benefit period starts when you’re admitted to a hospital or skilled nursing facility as an inpatient. It ends when you haven’t had inpatient care for 60 days in a row. So, you could pay the Part A deductible more than once within the same year.

You may have other costs for the healthcare services you receive while in the hospital. On the 61st day of a hospital stay, you would also start to have coinsurance costs. Your coinsurance costs depend on the length of your stay:

  • Days 61 to 90: Daily coinsurance of $389 in 2022 for each benefit period
  • Days 91 and over: Daily coinsurance of $778 in 2022 for each “lifetime reserve day” in each benefit period (up to a maximum of 60 days over your lifetime)
  • After lifetime reserve days are used up: You pay all costs.

For home healthcare services, all costs are covered under Medicare Part A for a limited time under certain conditions. However, if your doctor orders durable medical equipment and supplies it as part of your care, you’ll pay 20% of the Medicare-approved amount for the equipment.

For hospice care, all costs are covered. Some exceptions include:

  • If you take prescription medications or similar items for pain relief or symptom control while on hospice. You may be responsible for a copayment of no greater than $5 per prescription drug.
  • If you need inpatient respite services. You may need to pay 5% of the Medicare-approved amount for that care.
  • If you get hospice care in a nursing home. You typically pay for room and board costs.

Medicare deductible: Part B

Medicare Part B benefits include (but aren’t limited to) doctor’s office visits, preventive screenings, and durable medical equipment. A deductible for some of these services will apply ($233 in 2022). This is an annual amount, unlike with Part A.

Often, you will pay 20% of the Medicare-approved amount for a healthcarehealthcare service after this deductible is met. Check with your doctor and Medicare because each benefit’s coverage is different.

Frequently Ask Questions

How much does medicare part b cost?

Social Security will tell you the exact amount you'll pay for Part B in 2022. Most people spend the standard Part B monthly premium ($170.10 in 2022). You pay the standard premium if: ■ You enroll in Part B for the first time in 2022. You don't get Social Security benefits.

Do you have to pay for Medicare Part B?

Part B premiums
Railroad Retirement Board. You pay a premium each month for Part B. Your Part B premium will be automatically deducted from your benefit payment if you get benefits from Social Security.

What is the difference between Medicare Part A and B?

If you want to learn what Medicare Part A covers and Part B covers, Medicare Part A generally helps pay your costs as a hospital inpatient. Medicare Part B may help pay for doctor visits, preventive services, lab tests, medical equipment, and supplies.

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About Coach B.

After starting his financial career with Phoenix Home Life Insurance Company back in 1992, Scott decided he wanted to provide people with an easier and more enjoyable way to buy life insurance. That was the start of Coach B. Life Insurance, whose mission is to be transparent, honest, and helpful to customers — without ever bugging or pushing them.

In the years since then, he has worked tirelessly to improve the process of shopping for insurance. His goal is to make sure that everyone who comes to Coach B. — whether they end up buying a policy or not — has the best possible experience.

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