Medicare Part B Regulations

Medicare is an insurance program funded and administered by the federal government that services approximately 40 million people, according to the Medicare website. Medicare has several parts, but the two main parts are Part A and Part B. Part B is insurance to pay for medically necessary services and supplies, and most participants must pay a premium. Part B covers doctor visits, outpatient care, physical therapy and home health care, among other things. As with all aspects of Medicare, Part B has rules and regulations for those covered.

Eligibility

• A person must be at least 65 years old or legally disabled and receiving Social Security benefits to be eligible for Medicare Part B coverage. People receiving benefits from the Railroad Retirement Board (RRB) or Social Security usually are automatically enrolled in Part B. For the elderly, that coverage begins the first day of the month in which the person turns 65. Other eligible individuals have the option to choose whether to enroll in Part B coverage.

Enrollment penalties

• Information about enrollment into Part B is mailed to the address of the person eligible for coverage. That person must sign up for Part B coverage when he first becomes eligible, or he may have to pay higher monthly premiums as a late-enrollment penalty.

Premium requirements

• Part B requires that a premium be paid each month. The premium amount varies according to income, but it usually is $90 to $100 a month. Most people pay a standard premium, although it could cost more depending on a person’s modified adjusted gross income as reported on his tax return two years earlier.

Deductibles

• Out-of-pocket costs for services covered under Part B depend on whether the person has original Medicare or a Medicare health plan. If a Part B deductible applies, the enrolled person pays all costs until he meets a yearly deductible. After the deductible is met, Medicare typically pays 80 percent of additional Medicare-approved costs.