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Medicare Part B – Medical Insurance

Original Medicare is made up of Part A – Hospital Insurance and Part B – Medical Insurance. You can think of Part B as coverage for everything outside of the Hospital except for Prescription Drugs (which are covered under Part D). We go into more detail about Part B in the video below:

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What Does Medicare Part B Cover?

Covered services under Part B include:
  • Doctor visits (Primary Care and Specialist)
  • Emergency Room / Urgent Care
  • X-Rays and MRI’s
  • Preventive Services
  • Durable Medical Equipment (DME) like casts, crutches, diabetes test strips, and more.
  • Lab tests
  • Certain injectable medications that are received at the doctor/hospital
    How Much Does Medicare Part B Cost Per Month?

Most Medicare beneficiaries will pay the minimum amount of $164.90 per month (2023). Historically, this number tends to rise by at least a couple percent each year. Those who earned above average income for tax year 2021, will see an Income Related Monthly Adjustment Amount (IRMAA) amount added onto their monthly Part B premium.

Individual Tax Return (2021) Joint Tax Return (2021) Monthly Part B Premium (2023) Monthly Part D IRMAA (2023)
$97k or less
$194k or less
+ $12.20
+ $31.50
+ $50.70
+ $70.00
+ $76.40

Medicare Part B Cost Sharing

For 2023, there is a once per year deductible of $226 before your Part B will begin its coverage.

Once the deductible is met, Medicare Part B will cover 80% of Part B charges that are medically necessary and from a provider who accepts Medicare.

There is no maximum out-of-pocket limit for Part B, which means you pay 20% no matter how high that percentage gets.

When Do You Get Medicare Part B?

Most people who are no longer working will start their Part B at age 65.

If you are disabled, you typically get Medicare Part B once you’ve been on disability for 24 months, even if you are much younger than age 65.

If you’re working past age 65, whether you need to get Part B or not depends on the size of your employer health plan.

Under 20 employees – Medicare is primary, employer coverage is secondary. You will have to take Medicare Part A and Part B in order for your coverage to work properly.

Over 20 employees – Employer coverage is primary, Medicare is secondary. In most cases it does not make sense to take Medicare if you will be staying on your employer health coverage.

For many people, the benefits you can get on a Medicare plan will offer you better coverage than you can get on your employer health plan. Whether or not this makes sense for you depends on several factors. Reach out to us if you’re in this situation so we can do a Medicare Cost/Benefits Analysis for your specific costs.

Medicare sure can be confusing, huh? We made a video that goes through Medicare step-by-step. This is the easiest way to learn. Check it out!