Do I Have To Apply For Medicare Part B?
For more information on when you must apply for part B of Medicare, go to Benefits for People with Medicare.
If you have health insurance through an employer or union, you may not need to apply for Medicare.
What does Part B cover?
Part B covers some doctor visits, outpatient services, medical supplies, and some services provided by a hospital outpatient department. There are no monthly premiums for Part B services.
What is not covered by Part B?
Part B does not cover the following items or services:
Skilled nursing care
Teaching, research, or training of medical students or residents
What are Part B deductibles, coinsurance, and copayments?
The items and services that Part B covers are divided into the following four categories:
Major medical—Part B pays for 80% of the approved charges, and you pay the remaining 20% coinsurance. For example, if the doctor's approved charge is $100, you pay $20. (This amount is also called a copayment.)
Preventive—Part B pays 100% of the approved charges for certain recommended preventive services, such as flu shots and mammograms.
Semi-private hospital room and board—Part B pays for semi-private room and board in a hospital or nursing facility.
Hospital outpatient department services—Part B pays for certain services that are delivered in an outpatient department of a hospital. The approved charges for these services are listed in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, also called the Medicare Modernization Act.
How do I apply?
For detailed information on how to apply for Medicare Part B, go to the Medicare website.
What if I don't apply for Medicare Part B?
You may have to pay a penalty if you do not enroll in Part B when you are first eligible.
What if I have employer- or union-provided health insurance?
Part B does not cover any services that your private health insurance pays for. These services can include doctor visits, medical supplies, and some services provided by a hospital outpatient department. If you have health insurance from an employer or union, you may not need to apply for part B. You may want to check with your employer or union to find out if you need to enroll in Part B.
If you do not have health insurance from an employer or union, you will need to apply for Medicare Part B.
What if I have health insurance from a foreign country?
If you have health insurance from a foreign country, and have been living in the United States for at least 5 years, you have a special enrollment period to apply for Medicare. You must apply during the first 3 months of living in the United States. The enrollment period does not apply if you are eligible for Medicare because of age or because you receive Social Security Disability Insurance (SSDI) payments.
What if I want to apply for Medicare Part B later?
If you do not enroll in Part B when you are first eligible, you may enroll later as long as you are not enrolled in an employer or union health plan.
What happens if I decide to apply for Part B after I enroll in an employer or union health plan?
If you are enrolled in an employer or union health plan, and then decide to apply for Part B, your coverage under the employer or union plan may be ended for the time you are enrolled in Part B.
If you are on both Part B and an employer or union health plan, your doctor is paid by Medicare for Part B services. Medicare does not pay your doctor or other health care provider for services that the health plan also covers.
If you are enrolled in Part B and your doctor is willing to accept Medicare payments, Medicare will send you a notice asking you to choose a Medicare-approved health plan. If you choose a Medicare-approved health plan, Medicare will pay your doctor directly. If you don't choose a Medicare-approved health plan, Medicare will pay your doctor directly, and your doctor can choose whether to accept the Medicare payment.
What if I am 65 and live abroad?
If you are 65 and live abroad, you must enroll in Part B within the 8 months after you live outside of the United States for 30 continuous days. If you were living abroad on April 15, you would have to enroll in Part B by October 15. If you live abroad, and have health insurance from a foreign country, you may be able to apply for Medicare based on your own country's health insurance program.
How do I apply for Part D coverage?
If you decide to apply for Part D coverage, you will be given an opportunity to apply when you apply for Part B.
If you are 65 or older, you are automatically enrolled in the Prescription Drug Coverage (PDC) part of the Medicare prescription drug coverage program. You should receive a notification about your Part D coverage within a few days after you are enrolled in Part B.
You can also apply for Part D coverage at Social Security offices, at local Medicaid offices, or by calling Social Security at 1-877-690-1012.
For more information about the PDC part of the Medicare prescription drug coverage program, go to the Medicare website.
For more information about Part D, go to the Medicare website.
For information on your Part B benefits, go to the Medicare website.