Medicare Questions & Answers: Medicare Part B
Medicare Part B Q&A
Showing 11 questions
Why do some seniors end up paying lifelong penalties for Medicare Part B or Part D?
Lack of appropriate retirement planning education. One of the foundations I have built my business on is education. Medicare 101 seminars can be really useful to people to learn how to avoid these penalties.It is important to know that unless you have what is known as Creditable Coverage, delaying Part B and or Part D can carry lifelong penalties. Each situation is unique so it’s important to consult with a professional to understand if you have Creditable Coverage or not and have a plan in place, months before you turn 65. Sorting out your Medicare coverage is best done up to 3 months before you turn 65.
Why am I paying more for Medicare Part B and D than my friends? What is IRMAA and how is it calculated?
When clients ask why their Medicare Part B and D premiums exceed others’, I attribute it to IRMAA, the Income-Related Monthly Adjustment Amount, which increases costs based on higher income reported on their tax return from two years prior. Medicare discourages advisors like me from quoting specific thresholds, instead directing individuals to consult the official income brackets and resources to determine their financial responsibility two years hence. The calculation uses modified adjusted gross income, and significant income events—such as a large asset sale—can elevate the surcharge, often unexpectedly impacting their total premium obligation.
I just enrolled in Medicare, and I've got my Part A and B, but I'm hearing there are gaps in coverage. What are these gaps exactly?
The gaps come from Cost Share for Part A, Deductible of $257 and co insurance of 80/20% for Part B. In Part B you are responsible for 20% of the cost which is open ended. This means there is no maximum out of pocket. An example is a $60,000 hospital bill. You would be responsible for 20% or $12,000 of this cost. Provided everything billed is an accepted Medicare expense. I would be happy to go into this in more detail, please call me for further information.
How can I lower my Medicare Part B premium if my income drops after retirement?
All states have a threshold for “state Assistance” that if you are under then it will pay for your Medicare part B as well as some deductibles and some RX costs. If you don’t meet the financial criteria then your only other option to lower the part B cost is with a benefit called a “part B reduction”. Be careful when looking at plans that offer this because a few of them are “MA ONLY” plans which means they don’t include RX coverage. If you will be relying on your plan to get medications, then you want an MAPD with a part B premium reduction.
Why is regular Medicare better than an advantage plan?
There's a lot of confusion with Medicare-Medicare Supplement/Medigap/-Medicare Advantage "alphabet soup"! Do your homework and learn the Pros and Cons of each Option! Work with someone who can offer both: Medicare Supplement/Medigap and Medicare Advantage plans! This was you get the FACTS not the HYPE and then make the best decision for YOU! :)
How does Medicare Part B handle coverage for preventative screenings like mammograms?
Medicare Part B covers preventive screenings like mammograms as part of its focus on early detection and health maintenance, with specific rules on frequency, cost, and eligibility. Here’s how it works:Screening Mammograms: These are covered for women aged 40 and older to detect breast cancer early, before symptoms appear.
Frequency: Part B fully covers one screening mammogram every 12 months (anytime after 11 months from your last one). If you’re new to Medicare, you also get a baseline mammogram covered between ages 35–39.
Cost: There’s no out-of-pocket cost—no coinsurance, copayment, or Part B deductible—as long as the provider accepts Medicare assignment (agrees to Medicare’s payment rates). This applies to 2D and 3D (tomosynthesis) screenings, though 3D coverage was clarified in updates around 2018 to match evolving standards.
Diagnostic Mammograms: If a screening finds something abnormal or you have symptoms (like a lump), Part B covers diagnostic mammograms to investigate further.
Frequency: No strict limit—covered as medically necessary, which could mean multiple in a year if your doctor orders them.
Cost: After meeting the Part B deductible ($240 in 2025), you pay 20% of the Medicare-approved amount. There’s no cap on how many are covered, but each one triggers that 20% coinsurance unless you have a Medigap plan to offset it.
Key Details: The mammogram must be done at a Medicare-approved facility (like a radiology center or hospital outpatient department). If it’s bundled with other services (e.g., a biopsy), additional costs might apply under Part B’s standard rules. Preventive coverage assumes you’re symptom-free—once it’s diagnostic, it shifts to a treatment framework.
This setup reflects Part B’s broader approach to preventive care: full coverage for annual screenings to catch issues early, with cost-sharing kicking in when it’s about diagnosis or follow-up. It’s a balance between encouraging checkups and managing expenses when care escalates.
What’s the financial risk of sticking with Original Medicare without a Medigap plan?
I have a client who if she had went with her first choice of a Medigap plan her annual cost would be around $2,400. She decided to take a less expensive route and enrolled in a Medicare Advantage plan. She was diagnosed with a health issue requiring a doctor to administer shots in her eye every quarter for the remainder of her life. This cost is reaching her out of pocket maximum of $5,500 which is more than twice the annual cost of her supplement. In this particular case it would have been more cost effective for her to have been on the Medigap plan costing her $2,400 per year.
I’m on Medicare Part B, and I’m wondering how my physical therapy visits are covered. Do I have to hit my deductible first?
If your on Medicare A and B only you would 20%. If your on a Medicare Advantage Plan, it usually has a copay that would be deductible for the MOOP.I’m still working at 67, and I don’t know if I need Part B. Why is something so basic so hard to figure out?
It seems hard but when you know the specifics you can make the right decision for you!If you work for a company with 19 or more employees you can stay on that work plan until you retire and then get Part B!
Does Medicare Part A cover outpatient surgery, or is that strictly under Part B?
Medicare Part A does not cover Outpatient surgery. Medicare Part B covers outpatient surgery with 20% coinsurance you are responsible for.
I’m on Original Medicare with no supplement, and I’m wondering how much I’d pay if I need an ambulance ride to the hospital tomorrow.
Original Medicare generally covers ambulance services when they are medically necessary. This means that transportation in any other vehicle could endanger your health. This coverage applies to both emergency and certain non-emergency situations.Your Potential Costs:
- If Medicare covers your ambulance trip, you'll typically be responsible for 20% of the Medicare-approved amount.
- You'll also need to meet your Part B deductible for the year before Medicare begins to pay its share.
The actual cost of an ambulance ride can vary significantly depending on factors such as:
- The distance traveled.
- The level of care provided during transport (e.g., basic life support vs. advanced life support).
- Your location.