Every Medicare beneficiary will start with “Original Medicare,” which comprises of Medicare Part A and Medicare Part B. Part B is responsible for covering your doctor visits. Some people will be automatically enrolled in Part B at the same time that they are automatically enrolled in Part A, while others will have to enroll on their own.

Part B covers medically necessary doctor services and treatments as well as preventive services like yearly wellness visits. Other services like laboratory tests, x-rays, emergency transportation, durable medical equipment, mental health, and partial hospitalization.

Medicare will only cover emergency transportation (ambulance) if other transportation could put you in danger or you are having a medical emergency and need immediate assistance. It will only cover an ambulance ride to the nearest medical facility that can give you the type of care you need - you cannot request to visit a hospital that is further away. Medicare will only cover air transportation if you need to get to a facility quickly and cannot do so by ground transportation (for example, if there is heavy traffic or another obstacle on the ground).

Part B will only cover medical equipment if it is deemed durable. For an item to be considered durable medical equipment (DME), it must be able to withstand repeated use for at least three years, must be usable at home, and must be used for a medical purpose only. DME can include anything from a walker to a blood sugar monitor.

Every beneficiary will have a Part B premium. You will receive a bill each month. If you receive Social Security or Railroad benefits, your Part B premium will be automatically deducted from your monthly benefit payments.

Most beneficiaries will pay the same standard amount ($174.70 in 2024), but if you have a high gross income, you will have to pay an IRMAA (Income-Related Monthly Adjustment Amount).

You’ll need to meet a deductible of $240 per year before your coverage kicks in. Then, you’ll only have to pay 20% of the Medicare-approved amount for eligible medical services. Part B deductible can be waived through qualification of low income subsidies or enrollment in a Medicare Advantage Plan.

Yearly wellness visits are almost always no cost with Part B.

If you receive Social Security or Railroad benefits, you’ll automatically be enrolled in Part B. If you do not receive those benefits, you’ll need to sign up during your IEP (Initial Enrollment Period), which runs from three months before you turn 65 to three months after. If you do not enroll during your IEP, you’ll have to wait for the General Enrollment Period (Jan 1 - March 31) and will have to pay a late enrollment penalty fee.

Give us a call to get started on your enrollment process.

We can send an agent to your home to answer your questions about Medicare and help you sort through your options of Original Medicare, Medicare Advantage Plans, Medicare Supplements, and prescription drug plans.

To schedule your free appointment, call us at 520-760-6223.