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While Medicare Part A covers only the hospital service, Medicare Part B covers just about everything else, with the exception of prescription drugs (they are covered under Medicare Part D).


Medicare Part B is optional and there is a premium.  You can enroll in Medicare Part B any time during your Initial Enrollment Period (IEP).  Your IEP begins three (3) months before the month you turn 65, and ends three (3) months after the month you turn 65.  If you do not enroll in Medicare Part B during your initial enrollment period, you may be subject to a penalty for late enrollment, unless you have creditable coverage (i.e. group coverage).


Medicare Part B premium and deductibles remain the same in 2015 as they were in 2014.


Medicare Part B premium is indexed to your income.  If you are single, and your income is $85,000, or less ($170,000 for couples), the premium is $104.50.  If you are single and your income is $107,000, or less (double for couples), the premium is $146.90.  If you are single and our income is $160K, or less (double for couples), the premium is $209.70.  If you are single and your income is less than $214K (double for couples), the premium is $272.70.  If you are single and your income is more than $219K (double for couples), the premium is $335.70.  Medicare uses your modified adjusted gross income as reported on your IRS tax return from 2 years prior to determine what your premium level is.


Medicare Part B helps pay for some (but not all) medically necessary doctor’s services (inpatient and outpatient), durable medical equipment (wheelchairs, walkers, etc.), physical and occupational therapy, lab tests, blood (can be covered under Part A or Part B), ambulances and some preventative services.


Medicare Part B has an annual deductible, which is $147 in 2015.  It usually goes up a little each year, but not every year.  Once an individual has met the deductible, Medicare Part B pays 80% of “Medicare approved charges” and 100% of Medicare-covered lab services.


“Medicare approved charges” does not necessarily mean that Medicare will cover 80% of your doctor bills.  First, Medicare must approve the treatment that the provider does.  You should always talk to your doctor or other health care provider about why you need certain services or supplies, and ask if Medicare will cover them. If you need something that's usually covered and your provider thinks that Medicare won't cover it in your situation, you'll have to read and sign a notice saying that you may have to pay for the item, service, or supply.


If Medicare approves the treatment, they will then pay 80% of the portion of your bill that they approve.  For example, if your doctor charges $100, for a service, and Medicare approves $80, then Medicare Part B will pay 80% of the $80, or $64.  You are responsible for the remaining $16, and if your doctor does not accept Medicare’s “assigned” charges, you might have to pay all or a portion of the excess charges.


Medicare Part B also will pay for a preventative visit to the doctor once per year.  The Part B deductible is waived and Medicare pays 100% for this visit.  However, if your provider draws blood and sends it out to a lab, it might not be covered by Medicare.  It is important that you discuss this with your doctor prior.

Medicare Part B