Who Qualifies for Medicare Part B?

As you move closer to retirement age, it’s helpful to prepare for your next steps. Preparation often includes switching over to Medicare for health insurance needs, but you may not know where to begin. One way to start learning is to understand your Medicare eligibility, specifically for Medicare Part B. So, the question is: Who qualifies for Medicare Part B?

Medicare Overview

Medicare is a federal health insurance program for people 65 and up. People under 65 can also sign up for Medicare if they have a qualifying disability or health condition, including End-Stage Renal Disease.

The Medicare program consists of two main parts: Part A and Part B. Part A is your inpatient coverage, while Part B is your outpatient coverage. These two parts, also known as Original or Traditional Medicare, essentially act as the foundation for all your Medicare plans. Without Part A and Part B, you cannot sign up for other supplemental Medicare plans like a Medigap or Advantage plan.

To understand all the different parts and plans of Medicare, you may try to find a good Medicare agent to assist you. Doing so can make your Medicare enrollment process much easier.

Medicare Part B

Medicare Part B is coverage specifically for your outpatient care. These services can include surgeries, doctor’s visits, durable medical equipment, and more.

But Part B only pays for 80% of Medicare-approved services while you are responsible for the leftover 20%. If you have a Medicare Supplement (Medigap) plan, that plan will help cover some or all the 20% for you.

Medicare Part B Eligibility

Social Security bases your premium-free Part A eligibly on your work history. So, if you’ve worked in the U.S. for 40 quarters (10 years) or more and paid Medicare taxes during that time, you pay $0 each month for Part A.

If you don’t qualify for premium-free Part A, you will pay a monthly fee for your Part A benefits. You will pay either $274 or $499, based on the number of work quarters you have.

Fortunately, even if you must pay for Part A, you can still be eligible for Part B. However, there are a few more requirements you must meet. First, you need to be age 65 or older and a U.S. resident. Second, you need to be a U.S. citizen or have been a permanent resident for no less than five consecutive years.

When to Enroll

Like most people, you will presumably need to enroll in Medicare during your Initial Enrollment Period (IEP). Your IEP lasts for seven months, starting three months before your 65th birthday month and ending three months after. You can sign up for Part A and Part B through Social Security during this time.

If you don’t apply for Medicare during this time, you will begin to accrue late enrollment penalties. On top of that, you will have to wait until another valid enrollment period opens to enroll. This means you would have a coverage gap, leaving you vulnerable to all medical costs.

However, there are a few situations where you would not have to sign up for Medicare during your IEP and can avoid the penalties. For example, if you expect to continue working past 65, you may not need to sign up for Medicare, depending on the size of your employer.

Final Thoughts

You probably qualify for Medicare Part B, as many people do without issue. What you will want to focus on the most is your IEP. Be sure to mark your calendar for when this period starts, so you don’t miss this important enrollment window.

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