Medicare Part B – Medical
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Medicare Part B covers certain doctors’ services, outpatient care, medical supplies, and preventive services.
Medicare Part B costs include a monthly premium, a deductible, and a 20% coinsurance.
Summary of Medicare Part B Costs:
2025 –
$185.00 standard premium per person
$257.00 Deductible, 20% coinsurance
There is no maximum out-of-pocket
2024 –
$174.70 standard premium per person
$240.00 Deductible, 20% coinsurance
There is no maximum out-of-pocket
2023 –
$164.90 standard premium per person
$226.00 Deductible, 20% coinsurance
There is no maximum out-of-pocket
2022 –
$170.10 standard premium per person
$233.00 Deductible, 20% coinsurance
There is no maximum out-of-pocket
2021 –
$148.50 standard premium per person
$203.00 Deductible, 20% coinsurance
There is no maximum out-of-pocket
2020 –
$144.60 standard premium per person
$198.00 Deductible, 20% coinsurance
There is no maximum out-of-pocket
2019 –
$135.50 standard premium per person
$185.00 Deductible, 20% coinsurance
There is no maximum out-of-pocket
2018 –
$134.00 standard premium per person
$183.00 Deductible, 20% coinsurance
There is no maximum out-of-pocket
Refer to the SeniorViewsUSA Medicare Costs page for additional details on Medicare Costs and how Medicare Supplement (Medigap) will cover Medicare Part B coinsurance.
If you have a higher income, you will pay higher premiums for Medicare Part B and Medicare prescription drug coverage.
You pay nothing for most preventive services if you get the services from a health care provider who accepts assignment.
Part B covers 2 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: Annual wellness exams (not a complete physical, see below), health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best.
Part B covers things like:
Clinical research
Ambulance services
Durable medical equipment (DME)
Mental health
Getting a second opinion before surgery
Limited outpatient prescription drugs
Annual Wellness Exams (not a complete physical, see below)
Flu shots
Hepatitis B shots
Pneumococcal shots
Tdap shot (tetanus, diphtheria, and pertussis shot)
General list of items covered:
Other items may be covered depending on where you live.
Other items may be covered but you or your provider will have to contact Medicare.
You can try to look up the item to see if it is covered by Medicare. You can also ask your healthcare provider if the service is covered by Medicare or contact Medicare (1-800-633-4227).
Some of the items and services that Medicare Part A and Part B doesn’t cover include:
Long-term care (also called custodial care)
Most dental care
Eye exams related to prescribing glasses
Dentures
Cosmetic surgery
Acupuncture
Hearing aids and exams for fitting them
Routine foot care
Routine physical exams (wellness visit instead, see below)
Some vaccines are not covered by Medicare Part B. Generally, Medicare prescription drug plans (Part D) cover all commercially-available vaccines (like the shingles shot) needed to prevent illness.
Medicare will cover an annual wellness visit, but not an annual physical.
The Medicare Wellness exam includes the assessments, but none of the “physical” tests where the doctor has to physically touch you. Under Medicare, a doctor will only perform these types of services if there is a specific diagnosis or symptom which necessitates that type of examination.
It does not appear that any Medicare Supplemental (Medigap) coverage includes an annual physical.
Any additional tests or labs that may be required as a result of the findings of your annual wellness visit would be billed separately by your doctor and would fall under a different benefit than your annual wellness visit.
Medicare Wellness Visit vs Annual Physical
It is possible you will want to schedule a physical on a regular basis in addition to the Medicare Wellness exam.
It is possible issues will be detected with a physical that would not be detected with a Medicare Wellness exam.
Your costs in Original Medicare – Part B
If you have a higher income, you will pay higher premiums for Medicare Part B and Medicare prescription drug coverage.
For 2024,
If you file your taxes as “married, filing jointly” and your MAGI is greater than $212,000 ($206,000 for 2024, $194,000 for 2023, $182,000 for 2022), you’ll pay higher premiums for your Part B and Medicare prescription drug coverage.
If you file your taxes using a different status, and your MAGI is greater than $106,000 ($103,000 for 2024, $97,000 for 2023, $91,000 for 2022), you’ll pay higher premiums.
MAGI is
1) your total adjusted gross income as a starting point (for 2023 taxes, usually line 11 on IRS Form 1040) (for 2022 taxes, usually line 11 on IRS Form 1040)(for 2021 taxes, usually line 11 on IRS Form 1040) (for 2020 taxes, usually line 11 on IRS Form 1040) (for 2019 taxes, usually line 8b on IRS Form 1040)(for 2018 taxes, usually line 7 on IRS Form 1040) (for 2017 taxes or earlier, usually line 37/38 on IRS Form 1040)
2) plus some non-taxable items (possibly tax-exempt interest income and non-taxable Social Security),
3) less applicable deductions (possibly self-employed retirement and IRA contributions, half of self-employment taxes paid, health savings accounts or self-employed health insurance payments, and/or student loan interest and qualified tuition costs.).
Medicare Part B late enrollment penalty
“In most cases, if you don’t sign up for Medicare Part B when you’re first eligible, you’ll have to pay a late enrollment penalty. You’ll have to pay this penalty for as long as you have Part B and could have a gap in your health coverage..
There will be links in this article to various SeniorViewsUSA and Medicare sites. Just click on the link to get more details.
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