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September 9, 2012

Ohio Medicare Part B

What is Medicare Part B?

Medicare Part B is one of four insurances offered by Medicare in Ohio. It covers medically necessary services, like doctors' services, home health care services, outpatient care, and other medical services including some preventive services, such as blood tests. We'll look at some of the details of Ohio Medicare Part B and see if it's right for you.

If you're interested in Medicare Part B, it is first important to know if you will be automatically enrolled or if you must sign up on your own. Let's explore these situations:

  • Getting Enrolled Automatically - You will be automatically enrolled into Medicare Part B and A if you are already getting Social Security or Railroad Retirement Board (RRB) benefits. If you were born on the first day of the month, this will happen the month before your 65th birthday. If you were born on any other day of the month, it will begin the same month you turn 65. For example, a man born September 2nd will be enrolled in Medicare Part B in September, while a man born on September 1st will be enrolled in August.
  • Signing Up - If you are under 65 and receive disability benefits from either Social Security or the Railroad Retirement Board, you will receive Part A and Part B on the 25th month of your disability benefits. If you have Amyotrophic Lateral Sclerosis (Lou Gehrig's disease or ALS), you will be enrolled automatically with Medicare Part B and A the same month your disability benefits begin. If you have been diagnosed with End-Stage Renal Disease (ESRD), you are entitled to Medicare Part B, but you must sign up for it yourself, either online at or by contacting Social Security.

If you're interested in signing up for Medicare Part B but you aren't getting Social Security or RRB benefits because, for example, you might still be working, you should contact Social Security or the Railroad Retirement Board if you worked for a railroad, three months before you turn 65 in order to sign up.

Once you have been enrolled in Medicare Part B, you will receive your red, white, and blue Medicare card in the mail three months before the month of your eligibility. If you have decided that you don't want Medicare Part B, it is very important to follow the instructions that will come with the card and send the card back. If you don't, you'll keep Medicare Part B, and have to pay Medicare Part B premiums.

Another important note for anyone who has Medicare Part A and TRICARE (coverage for active-duty military or retirees and their families): in order to keep your TRICARE coverage, you must have Medicare Part B.

Costs of Medicare Part B

  • Premiums - The premium you will pay for your Medicare Part B benefits varies a little depending on your situation. Existing Medicare beneficiaries will not see a change in their premium amounts. They will continue to pay the same $110.50 or $115.40 premium amount. These are the amounts paid in 2010 and 2011, respectively. For people new to Medicare Part B, the standard monthly Part B premium will be $99.90, but if your income is above $85,000, if you are single, or $170,000, if you are married, your premium may be even higher. Medicare will notify you each year if your situation requires you to pay more than the standard premium.

    It is very important to note that the premiums explained above are reflective of 2012 only. Medicare Part B Premium amounts may change in the following years.
  • Deductibles and Copayments - For Medicare Part B services, there is a yearly deductible for each benefit period. In 2012, this deductible is $140. We need to look at Medicare Part B copayments more closely, because those are more variable, and it all depends on your doctor or healthcare provider. If your doctor's office accepts Medicare assignment of the Medicare-approved amount as the full payment for Medicare Part B services and supplies, your copayment for Medicare Part B eligible services will be 20%. If your doctor's office does not accept Medicare assignment, you can be charged by the office up to 15% over the Medicare approved amount. Altogether, you would be paying the 20% of the Medicare-approved amount plus the 15% additional charges. Clearly, when looking into Medicare Part B, it is important to call your healthcare provider and get information on their relationship with Medicare.
  • Medicare Part B Enrollment Penalties - It is very important to decide if you want Medicare Part B before you become eligible, because you will be penalized for enrolling after your Initial Enrollment Period. For each year that you delay Medicare enrollment into Part B, you will pay an extra 10% of the Part B premium. For instance, if you delay enrolling in Medicare Part B for two years, you will be paying an extra 20% of the premium amount. In most cases, this extra penalty is not taken off and you will be paying the higher premium every month for as long as you have Medicare Part B. An exception is if you have enrolled in Medicare Part B due to disability. Only in that case would the penalty be removed once you turn 65. Also, if you have a Special Enrollment Period, for instance, because you lost coverage from an employer or union, then you would not have to pay a penalty.

Medicare Part B Enrollment Periods

There are 3 different enrollment periods during which you can join Medicare Part B:

  1. The Initial Enrollment Period is a seven-month period that includes the three months before the month you turn 65, the month you turn 65, and the three months afterwards. If you are eligible because of disability, your month of eligibility would be your 25th month of receiving Social Security disability benefits.
  2. The General Enrollment Period is for anyone who didn't sign up for Medicare Part B or A when you were first eligible. This Period is from January 1st to March 31st of every year. Medicare Part B Coverage starts the following July 1 and you may have to pay the higher enrollment premium discussed earlier.
  3. The Special Enrollment Period is for people who lost coverage from a group health plan or through an employer or union. You will have an eight-month period to enroll that begins either the month after employment ends OR the group health coverage ends, whichever happens first.

Medicare has neither approved nor endorsed this information.