Medicare Questions & Answers: Medicare Part B
Medicare Part B Q&A
Showing 72 questions
What's the financial risk of sticking with Original Medicare without a Medigap plan?
A specific example: I've got a client at CMC who had some heart issues. The bill was $65,000. Thankfully, they have a Medigap policy, which will pay all of their 20% for them. Had they not had the Medicare Medigap supplement policy, they'd be paying $13,000 out of pocket, and I don't know who has that just laying around.
So please, before you make any decisions or non-decisions on Medicare, Original Medicare, Supplement, or Medicare Advantage, speak to someone like myself who deals with it every single day with clients and has real-life experience and real stories to tell about horror stories from making the wrong decisions.
I would be glad to help you. We'll go over the pros and cons of Original Medicare, sticking with that, or doing a Medicare supplement to add to A and B that will pay all of your out-of-pocket costs, or even going to a Medicare Advantage plan, which I believe would be better than sticking with just Original Medicare. Anyway, we're here to help. My office is right on Kelly Street in Manchester, Tony Capraro State Farm. Have a great weekend!
How can I lower my Medicare Part B premium if my income drops after retirement?
Depending on your personal situation you may qualify for a State Medicaid Program…and in certain situations have the State pay for the PART “B” premium.
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 Original Medicare ( Part A and Part B) only covers part of your healthcare costs. Beneficiaries must enroll in supplemental insurance plans to cover prescription drug costs, deductibles, co-pays, co-insurance, and the lack of a yearly out-of-pocket limit.The coverage gaps include prescription drug coverage, you can enroll in a stand-alone Part D drug plan.
Other gaps are routine vision, dental, and hearing. Consider enrolling in a Medicare Advantage plan. These plans are an alternative way to get the Original
Medicare, Part A, Part B, and additional benefits.
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?
Answering the first question first: it’s hard to figure out because the government wrote it! They don’t really understand how to make things simple.…Here’s the quick rule about employer insurance after age 65: if your employer has 20 or more employees and you are covered by the employer’s insurance and still working, you can delay part B as long as you want with no concern about having a penalty later. The moment that you stop working for that employer or discontinue that insurance, that’s the time that you need to enroll into Medicare part B in order to avoid a penalty.
I always advise my clients to compare the costs and coverage of the employer plan versus Medicare so they can make an informed decision.
I thought I signed up for both Part A and B when I got my Social Security, but now I'm getting bills for Part B. Did I miss something during the enrollment period?
Yup. If you don't speak to an experienced and honest agent, you won't know what your monthly payments will be. For example, there is a premium for the Part B, for the Part B one-time per year deductible, possibly a Medigap plan along with a Part D(rug) plan. If you want better coverage for the more expensive Dental, Vision & Hearing procedures, that can also be an extra cost per month. Sounds like you tried to get around using an agent whereas YOU are not paying for the agent's commission since the firm you chose pay the agents!
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.
My friend said she got a free annual physical with Medicare, but my doctor billed me. What's going on?
Medicare does not provide annual physicals; these are called wellness exams. If the doctor bills it as a physical, you will most likely pay 100%. However, if you have a Medicare Advantage plan, it may be covered as an annual physical under your policy coverage. All Medicare Advantage plans are different, and their coverage for these items varies; check your policy.Under traditional Medicare Part A and B, you can receive a yearly wellness exam. Talk to your doctor about the upcoming exam and what it entails.
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.
You will have a charge of the Part B deductible first which as of 2025 will be $257 and then 20% of the charge of the ambulance company charge in your area (state/city) you live.
Why is regular Medicare better than an advantage plan?
Making the choice between regular Medicare with Medigap/Medicare Supplement or a Medicare Advantage Plan depends on individual healthcare needs, preferences, and financial situations. Regular Medicare with Medigap/Medicare Supplement provides notable advantages in terms of flexibility, coverage, predictability, and support. Choosing to prioritize these factors you may find regular Medicare with Medigap/Medicare Supplement to be a superior option. Understanding the differences and benefits of each choice is essential for making an informed decision about healthcare coverage.
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.
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?
I am assuming you are on Original Medicare Part B and not an Advantage plan.Yes, you have to meet your Part B deductible then you would have copayments for those services. The deductible this year is $257.
My friend got her cataract surgery covered by Medicare, but they didn't cover the lens she wanted. How does that work?
Medicare does cover cataract surgery, and I have personally undergone the procedure. However, they only cover standard lenses, and you will need to pay extra if you want to purchase a premium lens or any other special types. These are considered luxury items or cosmetic options by Medicare and are not deemed absolutely necessary. Nonetheless, Medicare does cover the cost of the surgery as well as the standard lenses.
Why am I paying more for Medicare Part B and D than my friends? What is IRMAA and how is it calculated?
If you’re paying more for Medicare Part B (medical insurance) and Part D (prescription drug coverage) than other people you know, it’s likely due to something called IRMAA – the Income-Related Monthly Adjustment Amount.IRMAA is an additional amount that people with higher incomes must pay on top of their standard Medicare premiums. It affects Medicare Part B and Part D. The Social Security Administration (SSA) determines if you owe IRMAA based on your reported income.
Your friends might have a lower reported MAGI, different filing statuses, or different income sources. Even similar incomes can result in different IRMAA outcomes depending on deductions, tax-exempt interest, or capital gains.
My doctor recommended a bone density test. Is this considered preventive care under Medicare?
Yes, bone density screenings are considered preventive under Medicare Part B. They are typically covered every 24 months, however they can be approved more frequently if medically necessary.
I'm interested in nutrition counseling to help manage my diabetes. Will Medicare cover this as preventive care?
Medicare part B does cover with a referral from a doctor to a regestiered dietitan or specialist. But it all starts with your doctor.
I live in Tennessee, turn 65 in August, and signed up for Medicare Part A only. I have coverage through my wife’s Blue Cross Blue Shield plan, which she’ll keep for about seven more years. Will I owe a penalty now or later if I wait until she retires to get Part B?
You will not owe a penalty as long as you have creditable coverage that Medicare allows. Sometimes people do not know if there coverage is considered creditable and even the HR depts do not truly know if it's actually creditable coverage. Plus getting a Medicare Supplement at 65 allows you to get the lowest rate since it's based on age, gender and zipcode. I always suggest getting Medicare + Supplement Plan instead of keeping employer group coverage since the coverage is better on Medicare + Supplement and it's more cost effective long term.
I'm confused about all these different Medicare costs - premiums, deductibles, copays. How do they all work together?
All parts of Medicare have some cost associated, whether it be a premium, deductibles, copays for services, or even a max out-of-pocket.Premiums are the payments you make for the coverage. Deductibles are the amount you must pay out-of-pocket before your coverage will pay anything. Copays are the amount you pay for specific services after meeting your deductible.
Medicare Part A is free once you retire if you or your spouse worked for the last 40 quarters (10 years) before you signed up, because you paid taxes while working. Medicare Part A:
* Has a deductible for each benefit period (every 60 days) for inpatient hospital stays.
* Has copays for hospital stays longer than 60 days.
* Has daily coinsurance for days 61-90 and 91-150.
Medicare Part B has a premium that comes out of your Social Security check before it is dispersed to you. If you are not receiving Social Security, you must pay the premium for Part B out-of-pocket until you start drawing your Social Security. Medicare Part B:
* Has an annual deductible.
* Does not have copays for most services.
* Has a 20% coinsurance for most services after the deductible is met.
Medicare Supplements (Medigap) provide benefits to help cover out-of-pocket costs like deductibles, coinsurance, & copays. Each Med Sup has a premium, & each one has different benefits. Medigaps:
* Help pay the 20% coinsurance for services covered by Original Medicare Part B (medical insurance).
* Many cover the Medicare Part A (hospital insurance) deductible.
* May cover additional days in the hospital after Medicare benefits are used up.
* Some may cover costs for skilled nursing facilities, hospice care, excess charges from non-participating providers, & foreign travel health care emergencies.
Medicare Advantage usually does not have premiums, but may have a deductible(s), has copays for services, & an annual max out-of-pocket.
I signed up for part A. I'm still on my husband's insurance so I didn't sign up for part B. is there a form I need to fill out stating I'm still on my husbands insurance?
Once you’re ready to re-enroll in Medicare Part B, you’ll need to complete form CMS-40B. This form allows you to show proof of prior creditable coverage, which helps you avoid a late enrollment penalty.
I need a new wheelchair, and I'm not sure if Medicare will cover it. What's the process for getting durable medical equipment?
Original Medicare pays for DME, unless noted anywhere within its policy Medicare Advantage plans do not.You will have the 20% Co-pay responsibility, unless you have a Supplement plan that covers those charges.
That is an important feature in keeping your Original Medicare pays- it handles your DME, Medicare Advantage is typically handled Out-of-pocket by the insured.
My doctor wants me to try acupuncture for my back pain. Will Medicare cover any of this?
I'm considering a smartwatch that monitors my heart rhythm for atrial fibrillation. Will Medicare help cover this type of wearable technology?
No, Original Medicare Parts ( A and B) do not cover Fitness Smartwatches that track heart rhythm or other vitals. Also Original Medicare does not cover Medical Alert Devices. If you are interested in getting either and having it covered by Insurance, some Medicare Advantage Plans offer coverage for these devices.
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 a smoker trying to quit. What smoking cessation benefits does Medicare offer for someone in my situation?
Medicare provides some support to help beneficiaries who are trying to quit.Medicare Part B covers a variety of preventive services, and smoking cessation counseling is included.
Medicare Part D (prescription drug) plans may cover prescription medications or nicotine inhalers and nasal sprays that require a prescription.
I'm confused about which vaccines Medicare covers. Can you explain which ones are free?
Medicare Part B covers vaccines for the Flu, COVID, Pneumonia, and Hepatitis B. Part B also covers vaccines if you’re exposed to a harmful virus or bacteria by accident, such as a tetanus shot or rabies shotPart D (prescription drug) plans cover vaccines for RSV, Shingles, Tdap (tetanus, diphtheria, and pertussis/whooping cough), and vaccines that are "reasonable and necessary" to prevent illness and are not covered by Part B. Part D may also cover vaccines required to travel internationally.
Are preventative screenings covered by Medicare?
Most preventative services and procedures are covered under Medicare. Refer to your benefits explanation guide for specifics. There are other preventative procedures that must be medically necessary to be covered.
My doctor prescribed physical therapy, but I'm not sure how many visits Medicare will cover. How do I find out?
The number of physical therapy visits you get depends on what your doctor says. If the therapy is deemed medically necessary, Original Medicare will pay.However, if you have a Medicare Advantage plan and they deny the therapy, appeal the decision. MA coverage is required to be at least as good as Original Medicare so make sure your plan pays for what your doctor says you need.
My income fluctuates significantly year to year from investment distributions. How can I avoid IRMAA surcharges when I have an unusually high-income year?
IRMAA charges are calculated each year based on your tax return of two years ago. In any one year, you have a fluctuation, you can appeal an IRMAA by filling out an SSA-44 form. this can be found on and downloaded from the SSA.gov website.
I've heard Medicare covers an annual wellness visit. What exactly is included in this visit?
A Medicare Annual Wellness Visit focuses on preventative care and health planning, including a health risk assessment, review of medical history, and creation of a personalized prevention plan, but it's not a full physical
I'm considering concierge medicine but already have Medicare. How would these work together?
I have met with a local concierge Dr and she requested that if working with Medicare advantage, PPO plans would be a good fit since they are not in-network with the Medicare advantage plans. As of recently, one of the local health plans told me their HMO plan does work with concierge. So it sounds like they are more flexible now, don't need a PPO is what I've been told!
I have a family history of colon cancer. Will Medicare cover more frequent colonoscopies for someone in my situation?
If someone is deemed to be at high risk for colon cancer, Medicare will cover frequent colonoscopies every 2 years. Your doctor or other health care provider may recommend you get services more often than Medicare covers. An additional plan such as a Medicare Supplement or a Medicare Advantage can provide such additional coverage.Are mental health services like therapy fully covered under Original Medicare?
Mental health is covered but it is up to you to review different company policies since they could vary widely from state to state. There is a limited number of days that should be covered. It is incumbent upon you to fully understand those limitations. This is why it is imperative to go over with a knowledgeable agent who can easily differentiate between what an Advantage plan covers vs. what a Med. Suppmt. (Medigap) covers in this extremely important area.
I want to be proactive about my health. What preventive services should I be taking advantage of with Medicare?
medicare has a standardized list of preventive services that are covered as well as as a standard frequency when you should be getting these screenings. Your summary of benefits should have a list of these in your preventive services section. Sometimes the frequency can vary based on medical history and necessity. It’s important to work with your doctor to determine if your screening should be done more frequently than the standard.
Does Medicare cover chiropractic appointments?
I'm caring for my spouse with dementia and experiencing caregiver burnout. Will Medicare cover any mental health support for me?
If you’re on Medicare mental health is supported by Medicare as for your spouse with dementia Medicare will provide health care services. But you’d have to look into local caregivers to be able to help you as far as with with that, but not Medicare.I've been diagnosed with prediabetes. What preventive services does Medicare cover to help prevent progression to type 2 diabetes?
Preventive care is not done on the bases of your medicare but on the quality of care from your doctor. A good doctor will provide good care and education to prevent progression of illness. Depending on your insurance and dietary needs set by your physiscian, you can utilize benefits like nutrition health as well as gym memberships to support a good healthy habit which are typically included with your coverage.
I've been diagnosed with bipolar disorder at age 66. How should I structure my Medicare coverage to ensure I get the mental health care I need?
Medicare Supplements and Medicare Advantage plans cover mental health visits and hospitalization due to mental health. Part D prescription drug plans cover medications. Please contact your agent to see if your medications are covered. If you do not have Medicare yet, please contact a local agent to help you.
Does Medicare cover weight-loss programs or bariatric surgery if I’m classified as obese?
Medicare may cover certain weight-loss services if you’re classified as obese (BMI of 30 or higher), but coverage is limited. Medicare does not cover commercial weight-loss programs or meal plans. However, it does cover obesity screening and behavioral counseling through your primary care provider, and may cover bariatric surgery (like gastric bypass or sleeve gastrectomy) if you meet specific medical criteria, such as having other health conditions like diabetes or heart disease. Prior authorization and documentation are typically required.
I keep hearing about free preventive services with Medicare. What exactly is free and what will I still pay for?
Medicare covers preventive services that per the Medicare.gov website are identified as exams, shots, lab tests, and screenings. They key benefit that Medicare does not specifically cover are Routine Physical Exams. The majority of Medicare Advantage plans do cover a routine annual exam and typically they are a $0 copay.It is really important when setting up a routine physical exam with your doctor or provider that you have a good understanding of what services will be provided. For example, lets say your Medicare Advantage plan covers the routine physical exam which would include all of the $0 copay screenings, shots, and lab tests covered by Medicare. Those items would be a $0 copay. I never use the word free and Medicare does not allow a broker to ever use the word free.
It is common though that a good provider will ask you if there are other things you would like to discuss during your visit. Those items could be outside of the routine exam and you might have a copay for that portion of your visit. Lets say for example that you wish to discuss shoulder or knee pain you have been having. Those discussions are generally beyond your preventive $0 copay services and could trigger a copay for you.
In conclusion, its important to know that Medicare encourages all consumers to stay healthy and obtain the preventive services that have a $0 copay. It would only be services beyond or outside of the routine physical exam, tests, labs, screening that you might see additional costs.
Am I responsible for an IRMAA surcharge?
Yes. The IRMMA surcharge began in 2007 and focuses on higher income enrollees. They go back the past two years of income.Once One retires that income can decrease since the two year window will continually be changing.
If we choose a Medicare Advantage plan and later regret it, can we go back to Original Medicare without penalties?
Yes! You can return to Original Medicare without penalties. But this can only be done during AEP, OEP, or SEP. Be careful when you're changing. I recommend meeting with a licensed Medicare agent or contacting Medicare directly.
What is the best MAPD plan in South Carolina?
There is no such thing as the "best" MAPD in any zip code. Many factors such as hospital and provider networks and prescription drug coverage must be taken into account. Additionally in and out of network maximum out of pocket (MOOP) varies significantly among plans: HMO's, PFFS's & PPO's. For example, there may be six HMO's available in a zip code and the MOOP can vary by $1000's per year. As well as the requirement for pre-authorizations and referral approvals before care can begin.I'm confused about preventive services under Medicare. Which screenings are actually free?
When it comes to Medicare, with Medicare Part A and B and the additional purchase of a Medicare supplement, or some call it Medigap, you can receive several preventive screenings and services at no cost. Diabetes, colon cancer, depression, hepatitis B, hepatitis C, HIV, cholesterol, and mammograms can all be covered without cost, if you have a Medicare supplement plan added to your traditional Medicare Part A and B.
I'm at high risk for heart disease based on my family history. What additional preventive services might Medicare cover for someone with my risk factors?
Based on family history of heart disease, you may consider a Medicare Supplemental Plan, to go along with your original Medicare, this would give you the best coverage if you encountered major issues so your medical expenses would have the best coverage available to you.I'm homebound and need remote monitoring for my heart condition. What Medicare benefits might apply to someone in my situation?
There can be a wide variety of answers to this question due to the various symptoms that folks can have. There are tools that can be used to "remotely" signal to an outside location that your heart is working properly (or not). You will be beholden to your cardiologist who is your expert and will write up "A PLAN OF CARE" specifically for you. It might entail a number of hours a day where the doctor feels that a registered nurse ought to see you daily or every other day, depending upon the cardiologist's discretion. The other side of this coin is that I can only presume that an operation to remedy your dilemma is out of the question. It can sometimes have a lot to do with which plan you picked up at age 65 between a Medigap or Supplement vs. a Med. Advantage plan both of which demonstrate differing benefits.Does Medicare cover mammograms, and how often can I get them?
Medicare Part B has a very concise list of Preventive Services such as annual mammogram, cervical pap smear, and every other year bone density scan, etc. These are listed on the Medicare.gov website
How can I use Medicare to cover occupational therapy for arthritis or mobility issues, and what are the limits?
Medicare Part B covers occupational therapy as long as it is considered to be medically necessary and your provider recommends it. There are no limits to the number of occupational therapy sessions Medicare will cover, but you will pay 20% of the Medicare-approved rate after you have met your Part B deducible.If you are an inpatient in a hospital or skilled nursing facility, occupational therapy is covered under Medicare Part A.
When should my plan be reviewed?
You should review every year, before Dec 7th.You should also make sure all your doctors take that plan
How does Medicare cover outpatient mental health intensive programs for seniors with severe conditions?
Intensive Outpatient Program (IOP) services are covered under Medicare Part B and include intensive psychiatric care, counseling, and therapy. These services are provided in hospitals, Community Mental Health Centers, Federally Qualified Health Centers, Rural Health Clinics, and Opioid Treatment Programs (when services are for the treatment of Opioid Use Disorder).The beneficiary will pay 20% of the Medicare-approved amount after the Part B deducible has been met.
I need both a psychiatrist for medication and a therapist for talk therapy. How does Medicare coordinate coverage for these different providers?
Medicare provides coverage for both psychiatric medication management and talk therapy through its Part B (Medical Insurance) and Part D (Prescription Drug Coverage) plans.Psychiatric Medication Management
Medicare Part B covers outpatient mental health services, including visits with psychiatrists or other qualified healthcare providers for psychiatric evaluations and medication management. After meeting the Part B deductible, you typically pay 20% of the Medicare-approved amount for these services if your provider accepts assignment. Provider Acceptance: Not all mental health providers accept Medicare. It's important to confirm with your psychiatrist and therapist that they accept Medicare assignment to ensure coverage. Medicare Advantage Plans: If you're enrolled in a Medicare Advantage Plan (Part C), your plan may offer additional mental health benefits beyond Original Medicare. However, provider networks can be more limited, so verify that your preferred providers are in-network
I've heard about new AI-powered diagnostic tools for early disease detection. Does Medicare cover any of these cutting-edge technologies?
Yes, Medicare is increasingly covering AI diagnostic tools and services. AI is becoming a major player in all aspects of our lives and continues to grow in knowledge every day. It is being used to help diagnose people’s healthcare problems. However, it’s in its early stage and still needs to have the oversight of humans' approval before it can be accepted as a proper diagnosis.What is Medicare Part B?
Part b is the outpatient benefit of medicare. Its pays your benefits outside the hospital you will pay a premium amount each month based on your income,You must have part b in order to get a medigap plan or an Advantage plan.
What are Medicare’s coverage options for mental health apps or virtual therapy platforms for seniors with depression or anxiety?
One's coverage will depend on whether they are on the Original Medicare (Parts A & B), or a Medicare Advantage Plan (Part C). Both options will offer mental health coverage. However, the MA plans will include other options like the telehealth apps, group or single therapy sessions or other supplemental mental health services. These services can vary between plans.
How long after I apply for Medicare A&B will I receive my Medicare card?
Once you have applied and social security has enrolled you you should receive your card within 30 days.
Is there a penalty for Medicare Part A or B for a 65-year-old green card holder who hasn’t met the five-year U.S. residency requirement and has no other insurance?
Yes, a 65 year old green card holder without a 5 year residency or 10 year work history might face penalties for delaying Medicare Part A (if they have to pay for it) and definitely for Part B if they don't enroll when eligible.
If I have Medigap or secondary insurance, does it cover my Medicare Part A and Part B deductibles?
This will depend on which Medigap plan you have. If you have a plan F, yes they will be covered. If you have a plan G, the Part B deductible will not be covered but Part A will be. Other plans vary as well.
How do you avoid IRMAA surcharges on Medicare premiums?
You can’t always avoid IRMAA, but you can often reduce or minimize it through income planning. IRMAA is based on your Modified Adjusted Gross Income (MAGI) from two years ago, so large IRA withdrawals, Roth conversions, capital gains, and other taxable income can push you into a higher premium bracket.Strategies may include spreading withdrawals over multiple years, using Roth assets strategically, and working with a tax professional to manage taxable income. If your income drops because of a life-changing event such as retirement, you can request an IRMAA reconsideration through the Social Security Administration using Form SSA-44.
Planning ahead is often the best way to keep Medicare premiums lower.
Does Medicare cover shoulder replacement surgery?
Yes it will cover it based on medical needsYou also may want to get a 2nd opinon so you have the best posdible outcome
Is just Medicare Part A and Part B enough coverage, or do I need supplemental insurance?
Original Medicare (Part A and Part B) is generally not enough coverage for most, as it typically leaves you with 20% coinsurance, high deductibles, and no maximum out-of-pocket limit. Supplemental insurance—such as Medigap or a Medicare Advantage plan—is usually required to cover these gaps and protect against high, unpredictable medical costs.What are Medicare Part B excess charges, and how can I avoid them?
Part b excess charges are applied qhen you go to a doctor who does not take medicare assignment. The excess charge is 15%.You can avoid this by making sure your doctor takes medicare by asking them
Does everyone pay the same for Medicare?
No. While many people pay the standard Medicare Part B premium, higher-income beneficiaries may pay more due to IRMAA (Income-Related Monthly Adjustment Amount). Medicare Part D premiums can also be higher for those with higher incomes.In addition, costs vary depending on the coverage you choose, such as a Medicare Advantage plan, Part D plan, or Medigap policy. Some people also qualify for programs like Medicaid, QMB, or Extra Help, which can significantly reduce their Medicare expenses.
Which inhalers are covered by Medicare Part B vs Part D?
The best way to answer this is to give a list of inhalers you like to an agent or put them into a medicare rx calculator. Every insurance company is different.Can I cancel or drop Medicare Part B if I move abroad?
Yes, you can drop Medicare Part B if you move abroad, since Medicare generally doesn’t cover care outside the U.S. To do this, you must contact the Social Security Administration and submit a request to disenroll.Keep in mind, if you later return to the U.S. and want Part B again, you may face a late enrollment penalty and have to wait for an appropriate Enrollment Period.
Before dropping Part B, make sure you’ll have adequate health coverage in the country you’re moving to.
I’m 67, working full time, and previously had a 4-month job gap. I enrolled in Medicare A and B to avoid penalties, but SSA won’t let me disenroll from A. I haven’t claimed Social Security and don’t need Part A, which blocks my HSA. What can I do?
Best to call 1 (800) Medicare to get clarification when you are getting conflicting information. There are rules and restrictions with HSA.
Does Medicare have a deductible?
Yes! It is important to know what the deductibles will look like for each person. Please contact us to discuss your options.
Does Medicare cover heart monitors?
Typically Medicare does cover heart monitors when it is a medical necessity. A physicians order and documented symptoms are required. Heart monitors are considered Durable Medical Equipment, so once the Part B deductible is met Medicare pays 80% and the beneficiary pays 20%.Medicare does not cover devices like Apple Watch or a Fitbit. These are considered consumer electronics.
Does Medicare cover MRI scans?
If the MRI is medically necessary, they will cover it. Most times it is based on the diagnosis utilized for the client..
How to sign up for A & B?
You can sign up for Medicare Part A and Part B online through the Social Security Administration (SSA) website during your 7-month Initial Enrollment Period (3 months before to 3 months after your 65th birthday). The process takes about 10 minutes, and you will need to create a login.gov account.Several ways to Enroll:
- Online, visit SSA.gov and click "Sign up for Medicare".
- Phone: Call Social Security at 1-800-772-1213
- In-Person: Visit your local Social Security office.
Is IRMAA recalculated every year?
Yes, Medicare will use your yearly filed income taxes to reassess your Part B premium yearly.One year you might pay IRMAA if you were a higher income earner that year. Be careful of adding income to your adjusted gross income even after you start Medicare.
How long can I stay abroad without losing my Medicare benefits?
You can stay abroad indefinitely without losing your Medicare eligibility or benefits. Medicare enrollment itself is not terminated by extended time outside the U.S., but coverage for health care services received abroad is extremely limited, and there are important considerations for maintaining your coverage.
How long does the IRMAA surcharge last, and is it permanent?
IRMAA is income-based and uses the numbers from 24 months ago to determine your cost adjustment.While not necessarily permanent, if your income does not change, you will continue to pay the higher IRMAA charges.
Additionally, you do not necessarily have to wait the 24 months either; if you are retiring and your income drops substantially, you can ask for consideration. There are forms to submit to request this adjustment.
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