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 2024: The Standard Monthly Medicare Part Premium- $174.70

2024

The standard Part B premium amount in 2021 is $148.50. Most people pay the standard Part B premium amount. If your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount, you’ll pay the standard premium amount and an Income Related Monthly Adjustment Amount (IRMAA). IRMAA is an extra charge added to your premium.

If your yearly income in 2019 (for what you pay in 2021) was		You pay each month (in 2021)
Individual tax return	Joint tax return
$103,000 or less	$206,000 or less	$174.70
above $103,000 up to $129,000	above $206,000 up to $258,000	$244.60
above $129,000 up to $161,000	above $258,000 up to $322,000	$349.80
above $161,000 up to $193,000	above $322,000 up to $386,000	$454.20
above $193,000 and less than $500,000	above $386,000 and less than $750,000	$559.00
$500,000 or above	$750,000 and above	$594.00

DEDUCTIBLE

In 2024, the annual Part B deductible is $240

COINSURANCE

You pay 20% of the Medicare approved amount for doctors’ visits after you meet the $240 (year 2024) 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).