Medicare Part B: What Does it Cover & When to Enroll? (2024)

What is Medicare Part B?

Medicare Part B (medical insurance) is part of Original Medicare. Original Medicare is comprised of Medicare Part A and Medicare Part B. It’s a federal health insurance program designed to provide and reduce the cost of health care services in the United States. If you are eligible for Medicare Part A, then you can also enroll in Original Medicare Part B.

Am I Eligible for Medicare Part B?

You are eligible for Original Medicare, including Medicare Part B, if you meet one of three criteria:

• You’re aged 65 or older.
• You’re younger than 65 with eligible disabilities by the Social Security Administration.
• You have Amyotrophic Lateral Sclerosis (ALS) or End-Stage Renal Disease (ESRD).

What Does Medicare Part B Cover?

Medicare Part B covers preventative services and medically necessary services. This includes care to prevent an illness or detect it at an early stage – and services or supplies needed to diagnose or treat a medical condition.

Part B Medicare covers, but is not limited to:

• Orthopedic, Cardiology, Radiology, and other specialists
• Mental health services (inpatient, outpatient, and partial hospitalization)
• Screenings for common medical conditions (mammogram, colonoscopy, and more)
• Preventative care, including annual wellness checkups
• Vaccinations (flu, pneumococcal, Hepatitis B, and more)
• Clinical research
• Ambulance services
• Durable Medical Equipment (DME) (wheelchairs, blood pressure monitors, CPAP machines, and more)
• Limited outpatient prescription drugs

There are many tests, items, and services that are not covered by Medicare Part B. These include routine dental, vision, and hearing care – such as check-ups, eyeglasses or contact lenses, hearing aids, dental extractions, and dentures.

We recommend that you ask your provider if your medical service or procedure will be covered by your Medicare plan.

Curious about Medicare Part B’s costs? Read “Cost of Medicare Part B Premium, Deductible & More.”

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When to Apply for Medicare Part B

Know your Initial Enrollment Period

You are first eligible for Medicare during your Initial Enrollment Period. For most, the Initial Enrollment Period begins three months before your 65th birthday, the month you turn 65, and ends three months after your 65th birthday. You have this seven-month window to enroll in Medicare.

Should you miss your Initial Enrollment Period, you can enroll in Medicare Part B during the General Enrollment Period (January 1 – March 31), or a Special Enrollment Period, if you qualify.

Instances when you’re automatically enrolled in Original Medicare

• When you’re already receiving Social Security benefits, you’ll be automatically enrolled in Medicare Parts A & B starting the first day of the month you turn 65.
• If you are younger than 65 with an eligible disability by the Social Security Administration, the Initial Enrollment Period does not apply to you. You will automatically receive Medicare Parts A & B after receiving disability benefits from the Social Security Administration for 24 months.
• Have Amyotrophic Lateral Sclerosis or End-Stage Renal Disease? You’ll automatically get Medicare Part A and Part B the month your disability benefits begin.

Can I Delay Enrolling in Medicare Part B?

You can turn down or delay Medicare Part B enrollment. If you decide to enroll later on, your coverage could be delayed. And if you don’t have creditable coverage during that time, you may pay a late enrollment penalty.

Agent tip:

“If you decline Part B and don’t have creditable coverage, you could pay a late enrollment penalty that lasts as long as you have Medicare Part B.“

This penalty will be added to your Part B premium as long as you have Medicare Part B. The penalty could cause your premium to increase up to 10 percent for each year you were eligible for Part B and chose not to sign up – unless you qualify for a Special Enrollment Period.

Speak with a local licensed Connie Health agent to ensure you enroll in Medicare Part B at the right time. Call (623) 223-8884.

Not Yet Retired?

Suppose you are not retired and receive benefits from the Social Security Administration or Railroad Retirement Board at least four months before turning 65. You’ll need to sign up with the Social Security Administration to get Medicare Part A.

If you have private health insurance through your or your spouse’s employer, you can choose to delay Medicare Part B until you retire and receive Social Security benefits.

Considerations for delaying signing up for Medicare Part B:

• Most people pay a Medicare Part B premium. Determine whether it’s more cost-effective to be on Medicare Part B on your or your spouse’s private health insurance coverage.
• Your employer-based health insurance company may offer similar coverage to Part B medical insurance.
• You should check with your group health insurance plan administrator about how your health plan works with Medicare coverage – see what happens once you’re Medicare eligible.

End-Stage Renal Disease

You can enroll in Parts A & B if you’re eligible for Medicare because of End-Stage Renal Disease. You can choose whether or not to sign up for Part B. However, you’ll need Parts A & B to cover certain services under Medicare, including dialysis and kidney transplant services.

How to Sign up for Medicare Part B

Here are the four ways to apply for Original Medicare (Medicare Parts A & B) through the Social Security Administration. Already enrolled in Medicare Part A? Skip to the next section.

Choose the most convenient method for you:

1. Apply online at Social Security Medicare Benefits.
2. Visit your local Social Security office.
3. Call Social Security at 1-800-772-1213 (TTY: 1-800-325-0778). Representatives are available Monday through Friday, from 8:00 AM to 7:00 PM in all U.S. time zones.
4. If you worked for a railroad, call the Railroad Retirement Board at 1-877-772-5772.

Unfortunately, Medicare Part B doesn’t offer a maximum out-of-pocket. Once you are enrolled in Part B, ensure you explore supplemental Medicare insurance to protect yourself from high out-of-pocket costs and potential medical debt.

Your options include a Medicare Advantage plan or Medicare Supplement plan (Medigap). Call a local licensed Connie Health agent at (623) 223-8884 to review your plan options.

Already Enrolled in Medicare Part A?

Already enrolled in Medicare Part A, but previously declined Medicare Part B? You can enroll during your Initial Enrollment Period, General Enrollment Period, or a Special Enrollment Period. The timing depends on why you initially declined to enroll in Medicare Part B.

If you’d like help enrolling in Medicare Part B or determining if now is the right time for you to enroll, a local licensed Connie Health agent can help. We’ll review your specific situation and provide you the next steps to help you avoid late enrollment penalties. Call (623) 223-8884.

Read more about Medicare Part B’s costs: “Cost of Medicare Part B Premium, Deductible & More.”

Frequently Asked Questions

What does Medicare Part B cover?

Original Medicare Part B covers, but is not limited to:

• Visits to your doctor and specialists (orthopedic, cardiology, radiology, and others)
• Mental health services (inpatient, outpatient, and partial hospitalization)
• Screenings for common medical conditions (mammogram, colonoscopy, diabetes, and more)
• Preventative care, including annual wellness checkups
• Vaccinations (flu, pneumococcal, Hepatitis B, and more)
• Clinical research
• Ambulance services
• Durable Medical Equipment (DME) (wheelchairs, walkers, blood pressure monitors, CPAP machines, and more)
• Limited outpatient prescription drugs
• Medically necessary services and supplies.

There are many tests, items, and services that are not covered by Medicare Part B. These include routine dental, vision, and hearing care – such as check-ups, eyeglasses or contact lenses, hearing aids, dental extractions, and dentures.

We recommend that you ask your provider if your medical service or procedure will be covered by your Medicare plan.

What is Medicare Part B?

Medicare is a federal health insurance program designed to provide and reduce the cost of health care in the United States. Medicare is available to people aged 65 and older, younger individuals with disabilities, and people with End-Stage Renal Disease.

Medicare is divided into several parts, with Medicare Part A covering hospital insurance and Medicare Part B covering medical insurance. If you are eligible for Medicare Part A, then you can also enroll in Original Medicare Part B.

Medicare Part B is optional and covers two types of services:

• Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.
• Preventive services: Health care to prevent illness or detect it at an early stage, when treatment is most likely to work best.

Opting for Medicare Part B is a choice, but for many, it’s a crucial aspect of their healthcare plan, providing broader protection against the costs of medical care.

How to apply for Medicare Part B?

There are the four ways to apply for Original Medicare (Medicare Parts A & B) through the Social Security Administration.

Choose the most convenient method for you:

1. Apply online at Social Security Medicare Benefits.
2. Visit your local Social Security office.
3. Call Social Security at 1-800-772-1213 (TTY: 1-800-325-0778). Representatives are available Monday through Friday, from 8:00 AM to 7:00 PM in all U.S. time zones.
4. If you worked for a railroad, call the Railroad Retirement Board at 1-877-772-5772.

Unfortunately, Medicare Part B doesn’t offer a maximum out-of-pocket. Once you are enrolled in Part B, ensure you explore supplemental Medicare insurance to protect yourself from high out-of-pocket costs and potential medical debt.

Your options include a Medicare Advantage plan or Medicare Supplement plan (Medigap). Call a local licensed Connie Health agent at (623) 223-8884 to review your plan options.