Understanding Medicare Part B


Transitioning from a traditional healthcare marketplace to Medicare can be overwhelming. M3 Elevate’s Medicare team has been helping individuals navigate Medicare for over a decade and can assist with finding the best plan and value. The transition can be simplified with an expert at your side.

Today, we are highlighting key pieces of information regarding Medicare Part B. Within the FAQ’s, you will find valuable resources, tips, and advice.

Medicare is the United States’ health insurance program commonly used for individuals 65 + and those with disabilities. Each individual enrolled in Medicare will receive a Medicare card with a unique number enabling identity protection.

The four parts of Medicare include: Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage plans), and Part D (prescription drug coverage).

What is Medicare Part B?

Medicare Part B covers reasonable and necessary services

  • Physicians’ services inpatient and outpatient
  • Outpatient medical services and supplies
  • Outpatient lab and x-ray
  • Outpatient physical, occupational, and speech therapy
  • Preventive care
  • Ambulance services
  • Chiropractic services
  • Outpatient mental health care

Medicare Part B helps pay for doctors’ services, supplies, and additional medical services that hospital insurance doesn’t cover. M3 Elevate’s Medicare team can help individuals understand their options and provide Medicare recommendations.

What is the monthly premium for Medicare Part B?

In 2022, the standard Medicare Part B premium for medical insurance is $170.10. Please note that some individuals who collect Social Security benefits and have their Part B premiums deducted from their payment will pay less. This is because their Part B premium increased more than the cost-of-living increase for 2022 Social Security benefits. Social Security will send a letter to all people who collect Social Security benefits (and those who pay higher premiums because of their income) that states each person’s exact Part B premium amount for 2022.

Since 2007, higher-income beneficiaries have paid a larger percentage of their Medicare Part B premium than most. Depending on their income, these higher-income beneficiaries will pay premiums that amount to 35, 50, 65, or 80 percent of the total cost of coverage. The chart below reflects the adjustment in cost based on income.

Beneficiaries who file individual tax returns with modified adjusted gross incomeBeneficiaries who file joint tax returns with modified adjusted gross incomeIncome-related monthly adjustment amountTotal monthly premium amount
Less than or equal to $91,000Less than or equal to $182,000$0.00$170.10
Greater than $91,000 and less than or equal to $114,000Greater than $182,000 and less than or equal to $228,000$68.00$238.10
Greater than $114,000 and less than or equal to $142,000Greater than $228,000 and less than or equal to $284,000$170.10$340.20
Greater than $142,000 and less than or equal to $170,000Greater than $284,000 and less than or equal to $340,000$272.20$442.30
Greater than $170,000 and less than $500,000Greater than $340,000 and less than $750,000$374.20$544.30
Greater than or equal to $500,000Greater than or equal to $750,000$408.20$578.30

How do I sign up for Medicare Part B if I already have Part A?

Individuals who are enrolled in Medicare Part A have the opportunity to enroll in Part B during the Special Enrollment Period (SEP). If you did not sign up for Part B when you were first eligible because you were covered under a group plan, you can still sign up any time you or your spouse are covered by a group health plan. You can also enroll during the 8 months period after your employment ends or your group health coverage plan coverage ends, whichever occurs first.

Upload an application and documents online at Apply for Medicare Part B Online during a Special Enrollment Period to verify your group health plan coverage through your employer.

An additional option is to fax or mail your completed Application for Enrollment in Medicare – Part B (CMS-40B), Request for Employment Information (CMS-L564), and evidence of employment from your local Social Security Office. For questions, please contact Social Security at 1-800-772-1213 (TTY 1-800-325-0778).

Tips for Completing CMS-40B and CMS-L564

  • State “I want Part B coverage to begin (MM/YY)” in the remarks section of the CMS-40B form or online application
  • If your employer is unable to complete Section B, please complete that portion as best as you can on behalf of your employer without your employer’s signature
  • Also submit one of the following forms for secondary evidence:
    • Income tax returns that show health insurance premiums paid
    • W-2s reflecting pre-tax medical contributions
    • Pay stubs that reflect health insurance premium deductions
    • Health insurance cards with a policy effective date
    • Explanations of benefits paid by the GHP or LGHP
    • Statements or receipts that reflect payment of health insurance premium

Can I sign up for Medicare Part B if I am working and have health insurance through an employer?

The decision to enroll in Medicare Part B depends on your situation and type of health insurance you currently have. In most cases, if you do not sign up for Part B when you’re first eligible, you’ll have to pay a late enrollment penalty for the duration you have Part B.

However, you may be able to delay signing up for Medicare Part B without a late enrollment penalty if you or your spouse are working, and you’re getting health insurance benefits based on current employment (excludes: Consolidated Omnibus Budget Reconciliation Act, Retiree health coverage, Veterans Affairs health coverage, or individual health coverage).

Delay coverage for Part B based on employer coverage

  • If you will be covered by a group plan with less than 20 employees, Medicare pays a primary so we recommend enrolling in Medicare Part A and Part B
  • If you will be covered by a group plan with 20 or more employees, you can apply for Medicare Part A only and delay Medicare Part B, as your group plan pays as primary payer in this case
  • If you have group coverage and declined Part B when you turned 65, about 3 months prior to leaving your group plan, you can contact Social Security and tell them you need to activate your Medicare Part B coverage
    • A form will need to be completed by your group administer to verify you had group coverage after you turned 65 and the date your group coverage will end

What happens after I am enrolled?

After you are enrolled, The Centers of Medicare & Medicaid Services (CMS) will send you a Welcome to Medicare packet and Medicare card in the mail. You will also receive the Medicare & You Handbook which contains information regarding your Medicare coverage choices.

If you or your employees are interested in learning more about Medicare Part B, turn to M3 Elevate for guidance and recommendations. M3 Elevate’s Medicare team is ready to assist you with your questions.

Sources: medicare.gov and ssa.gov

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