Understanding Medicare and all its different coverages can be confusing. However, a basic understanding will help you get going in the right direction. The first thing you need to understand is that there are two different parts to Original Medicare. They are known as Part A, and Part B.
Medicare Part B, or medical insurance, is the part of Original Medicare that covers medical services and supplies considered medically necessary to treat your health condition. This could mean outpatient services, preventive care, ambulance services, and durable medical equipment.
Medicare Part B covers some preventive services including a one-time preventive visit, flu, and cardiovascular screenings, hepatitis B shots, cancer and diabetes screenings, and other services.
Medicare Part B is an automatic enrollment for some, and for others, you will need to sign up for Part B. It’s important that you sign up for Part B when you first become eligible, or you may need to pay a late enrollment penalty.
First, you must understand that premiums for Medicare Part B can change from one year to the next, and the dollar amount you pay is different for every situation based on personal circumstances. Many people have Part B premiums taken out their Social Security benefits.
For those that signed up for Medicare Part B before 2018 and collecting Social Security benefits, their monthly premiums may be less than those enrolled in 2018. On average, those enrolled before 2018 pay around $130. If any statements below apply to your situation you could pay around $134 moving forward:
Individuals who receive benefits from Social Security, Railroad Retirement Board, or federal retirement, the Medicare Part B premium in 2019 will be taken from your monthly benefit. If none of these apply, then you will be billed every three months.
Below you can find Medicare Part B monthly premium amounts, subject to individual income. Be sure to understand that these premiums could change every year. Plus, you may be subject to a penalty for late enrollments if you chose not to enroll for Medicare Part B during the initial enrollment period. For example, your monthly premium could be 10% more for each 12-month stretch of eligibility that you didn’t sign up for Part B.
In 2018 the yearly deductible for Medicare Part B was $183 as well as coinsurance of 20% for several covered services.
In some situations, your physician or healthcare professional may accept an assignment for services covered, and you will be responsible for the Part B deductible along with 20% of the approved amount by Medicare for care provided. Taking an assignment means that your doctor is saying they will not bill you more than the amount approved by Medicare for the covered care. You will still cover any cost-sharing.
Understand that some providers may not accept an assignment. If they do not, they are deemed “nonparticipating” providers; meaning they did not sign an agreement with Medicare to offer services at a standardized rate or agreed-upon price.
Going to one of these providers for a Medicare-covered service could cost extra. There may be other consequences that you may be subject to as well for going to a nonparticipating provider.
The consequences of nonparticipation may include:
There may be some consequences of choosing a nonparticipating provider, but under Medicare, there are rules they must adhere to. A provider is not allowed to charge you a fee for submitting a claim for you. In the event this happens to you, please give Medicare19.com a call at 844-374-1950, and we’d be glad to walk you through the process of reporting a grievance.
The good news is that most physicians and other healthcare professionals that take Medicare will also take an assignment. So, don’t worry too much about using nonparticipating providers. That doesn’t mean you shouldn’t ask your current doctor before enrolling in Medicare. It’s always wise to double check to make sure you’re covered. The Medicare website allows you to check for nonparticipating providers, but the simplest way to find out is to ask in person. The benefit of choosing a provider that accepts assignment is reducing your medical expenses over the long-term.
If you qualify for premium-free Medicare Part A, then you may be eligible for Medicare Part B. If you do not meet the premium-free Medicare Part A requirements, you can still sign up for Medicare Part B by meeting the following criteria:
Please understand that limitations, copayments, and restrictions may apply. Benefits may change on every year on January 1.
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