What services does Medicare Part B pay for?

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Medicare Part B helps pay for medical care you get when you’re not in the hospital. This includes visits to the doctor; mental health care; home health services; screening exams, procedures and tests; supplies and equipment; occupational, speech, and physical therapy; immunizations; and other outpatient services.

Part B will only pay for these expenses when they are medically necessary. If they’re not determined to be medically necessary, Part B won’t pay for them.

Who is eligible for Medicare Part B?

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As with Part A, people with disabilities automatically get Medicare Part B coverage after they have received Social Security Disability Insurance (SSDI) or Childhood Disability Benefits (CDB) payments for 24 months.

You can also get Medicare Part B if you have End Stage Renal Disease (permanent kidney failure), Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig’s Disease), or if you have reached age 65.

How is Medicare Part B different from Part A?

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Medicare Part A helps pay for medical costs while you’re in the hospital or a Skilled Nursing Facility; Medicare Part B helps pay for visits to the doctor and other outpatient services. While Part A usually doesn’t require a premium, most people have to pay a premium to be on Part B.

How much is the Part B premium?

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The Part B premium is $135.50 per month (or a bit less) in 2019, unless you make more than $85,000 a year. You may qualify for certain Medicare Savings Programs or other help paying for the cost of your Part B premium.

Can I choose to enroll in Medicare Part A but decline Part B?

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Yes. If you decline Part B coverage and decide later that you want it, you may have to pay a penalty. If you don’t have any other health coverage, you’ll have to pay a 10% penalty for each year that you declined Part B coverage.

Aside from the monthly Part B premium, what else will I have to pay for?

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Each of the services covered by Medicare Part B has its own rules about how much Medicare will help pay for. For example, Medicare will cover the entire cost of a flu shot but it generally only covers 80% of the costs for mental health services. For several other services, Medicare pays for 80% of the cost and you pay for the other 20%. The amount that you pay for yourself is called coinsurance.

If I qualify, will Medicare Savings Programs help pay my Part B premium?

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Yes. If you qualify, the Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), and Qualified Individual (QI) programs will all pay your Medicare Part B premium for you.

For details on eligibility and enrollment, see Medicare Part B: Help Paying for Part B Premiums and Costs.

What if I’m not eligible for a Medicare Savings Program? Are there other programs that will help cover my Part B costs?

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Yes. See Part B: Other Help from Medi-Cal for more information.