When you turn 65, you have many decisions to make regarding Medicare. There’s a lot to learn, too. What Parts do I need? What does each Part cover? Can I choose to delay coverage if I have insurance benefits through my employer? Note that we address all of these questions on our blog and within our eBook (links included below). However, in this article, we’ll discuss Medicare Part B, specifically – can you skip it? Are there penalties? Here’s what you need to know.
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So, Can I Skip Medicare Part B Coverage?
Medicare Part B enrollment is typically automatic for people receiving Social Security. You can delay Part B enrollment (or disenroll if you’ve been automatically enrolled) if you have coverage through your or your spouse’s employer. However, if your Medicare coverage is primary, Part B is essential to your overall health benefits (see what Part B covers below). If any of these situations apply to you, you should enroll in Part B:
- You’re 65, and you have employer coverage through a company with fewer than 20 employees
- You’re younger than 65 and on Medicare because of a disability, and you’re employed at a company with fewer than 100 people
- You have retiree coverage from another employer
- You are 65 + and enrolled in Medicaid
- You are about to be 65 with Tricare for Life (TFL) or CHAMPVA
- You have COBRA insurance (you are required to enroll in Part B by the 8th month of your COBRA coverage)
- You want to enroll in a Medigap plan (you may not be eligible for supplemental coverage if you are not enrolled in part B)
Note that if you are in any of the above categories, and you fail to enroll in Part B, you may be responsible for 80% of any outpatient expenses you incur (see Part B coverage below), and your secondary coverage may not pay at all.
What Does Part B Cover?
Medicare Part B covers out-patient medical services, including:
- Medically Necessary Outpatient Services – A service will be determined as “medically necessary” if it is needed to effectively diagnose and treat a health condition. Some medically necessary services include doctor office visits.
- Durable Medical Equipment – This includes wheelchairs, crutches, home hospital beds, diabetic supplies, etc.
- Preventive Services – This includes services that help prevent illnesses, like the flu, or detect illnesses at earlier stages when treatment is most likely to be more effective.
Some things that fall into the above categories of medical services covered by Part B include chemotherapy, ambulance services, occupational therapy, and injections given by your doctor.
Read about covering Part B coverage gaps here.
If you are unsure if your Medicare Part B covers a specific medical service, give Delta Benefits Group a call at (901) 460-7220. Our Medicare consultants will be glad to help you better understand your coverage.
Watch Out for Part B Penalties
While Medicare allows a secondary enrollment period in the General Enrollment Period (GEP), beneficiaries should know that they may still incur penalties for the late enrollment. If you don’t sign up for Medicare during your Initial Enrollment Period (IEP), you may incur a 10% penalty as a result of not signing up for Medicare Part B. Part B late penalties are calculated at 10% for every 12-month period you would have had Part B. This penalty will be added to your Part B premium once you do sign up, and you will be responsible for the extra percentage for the remainder of your Part B coverage.
For example, if your Initial Enrollment Period (IEP) ended in January 2020, and you waited until March 2021 to sign up for Part B Medicare during the General Enrollment Period (GEP), your coverage will have begun July 1, 2021. Your penalty would be 10% of the standard premium, and you will have to pay the premium penalty for as long as you have Part B. Note that even though, in this example, you would have withheld Part B enrollment for a total of 15 months, you are only penalized for one full 12-month period in which you did not enroll.
Read more about Medicare enrollment periods here.
Schedule a Free Appointment with Our Medicare Experts
Are you unsure about your Medicare options? We’re here to help! To schedule a free appointment, give us a call at (901) 460-7220. You may also fill out the convenient and secure contact form on our website. We look forward to walking you through your benefits to ensure you have the knowledge you need to take control of your healthcare and health budget.
