By Debbie D.

Before turning 65, you have a few decisions to make regarding what kind of health coverage works best for you. Social Security automatically enrolls you in Original Medicare, which includes Part A (hospital insurance) and Part B (medical insurance). Original Medicare helps with the cost of healthcare but does not cover all medical expenses or costs related to long-term care. Many recipients choose to purchase supplemental insurance plans to expand their coverage.

Anyone eligible for premium-free Medicare Part A is eligible for Medicare Part B by enrolling and paying a monthly premium. If you are not eligible for premium-free Medicare Part A, you can qualify for Medicare Part B by meeting the following requirements:

  • You must be 65 years or older.

  • You must be a U.S. citizen, or a permanent legal resident living in the U.S for at least five continuous years.

  • You may also qualify for automatic Medicare Part B enrollment if you are under 65 and receiving Social Security or Railroad Retirement Board (RRB) disability benefits.

  • You will automatically be enrolled in Medicare Part A and Part B after 24 months of disability benefits.

  • You may also be eligible for Medicare Part B enrollment before 65 if you have end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (also known as ALS, or Lou Gehrig’s disease).

What is Medicare Part B?

Medicare Part B (medical insurance) is part of the Original Medicare plan and covers medically necessary services and supplies to treat your health condition. This can include outpatient care, preventive services, ambulance services, and durable medical equipment (wheelchairs, oxygen, etc.). If prescribed by your doctor, Part B also covers part-time home health and rehabilitative services, such as physical therapy.

Medicare Part B services include a one-time, comprehensive “Welcome to Medicare” visit, that includes flu and hepatitis B shots, cardiovascular screenings, cancer screenings, diabetes screenings, and more.

What Does Medicare Part B Cover?

  • Services, tests, or supplies that are needed to diagnose or treat a medical condition

  • Ambulance services

  • Durable medical equipment (wheelchairs, walkers, oxygen, etc.)

  • Mental health (inpatient and outpatient)

  • Clinical Research

  • Approved outpatient prescription drugs

  • Chemotherapy

  • Emergency room visits

  • Kidney dialysis

  • Laboratory testing

  • Occupational therapy

  • Imaging tests and echocardiograms

  • Physical therapy

  • Organ transplants

Medicare Part B also covers certain preventative services like:

  • Bone density measurements

  • Cancer screenings

  • Cardiovascular disease screenings

  • Diabetes screenings

  • Screenings for HIV, hepatitis B, and hepatitis C.

  • Screenings for sexually transmitted infections (STI)

  • Vaccinations for flu, hepatitis B, and pneumonia

  • Wellness checks

What Home Health Care Services are Covered by Medicare Plan B?

Home health care approved as medically necessary is completely covered and must be provided by a Medicare-certified home healthcare agency. These services may include:

  • Part-time skilled nursing care

  • Physical therapy

  • Speech-language pathology services

  • Occupational therapy

  • Medical social services

  • Limited home health aide services

To be eligible for home health care services, a physician must certify that you are homebound. According to Medicare, you are homebound if you can’t leave home without the aid of another person, specialized transportation, or equipment.

Medicare Part B does not cover 24-hour home care, meals, or housekeeping services that are unrelated to your treatment. It also does not cover personal care services, such as help with bathing and dressing, if this is the only care that you need.

Medicare Part B: Eligibility

You automatically qualify for Medicare Part B once you turn 65 years old although you’ll need to enroll during your seven-month Initial Enrollment Period (IEP) which begins three months before your 65th birthday, includes the month you turn 65, and ends three months later.

If you have a disability and are receiving Social Security payments, you’re eligible to enroll in Medicare Part B, regardless of your age.

According to the Social Security Administration, other covered disabilities may include:

  • Sensory disorders

  • Cardiovascular and blood disorders

  • Digestive system disorders

  • Neurological disorders

  • Mental disorders

  • End-stage renal disease (ESRF) that requires dialysis

  • Amyotrophic lateral sclerosis (ALS)

Most people pay the standard Part B premium amount of $148.50.

Medicare Part B: Initial Enrollment Period (IEP)

The seven-month Initial Enrollment Period (IEP) for Medicare benefits begins three months before your 65th birthday includes the month you turn 65, and ends three months later. If you do not enroll during your seven-month IEP, you will be required to wait until the next general enrollment period, January 1st to March 31st.

Part B benefits begin the first day of the month you turn 65. If your birthday is on the first day of the month, your benefits will begin the month before you turn 65. Your Medicare card will arrive about three months before your 65th birthday.

If you are disabled, enrollment in Medicare Part B will begin after you have been receiving Social Security disability benefits for 24 months. Your coverage will begin in the 25th month. You will receive your Medicare card about three months before your coverage begins.

If you have amyotrophic lateral sclerosis (ALS), your Medicare Part B medical insurance will automatically begin the same month that your Social Security disability benefits begin. Your Medicare card will arrive about one month after you sign up for Social Security disability benefits.

If you have end-stage renal disease (ESRD) and require dialysis, your Medicare effective date is usually the first day of the fourth month of your dialysis treatments. However, you need to apply for Medicare benefits; you’re not automatically enrolled if you’re younger than 65.

Medicare Part B: General Enrollment Period

If you were late enrolling for Medicare or need to make changes to your coverage, you may enroll during the next available General Enrollment Period (GEP). The GEP occurs each year from January 1 to March 31 and If you sign up during general enrollment, your coverage will begin July 1 of that year. Your Medicare card will arrive about three months before your coverage begins.

Medicare Part B: Special Enrollment Period

You may be eligible for a Special Enrollment Period (SEP) if you have moved or lost your group health insurance. You have 8 months to sign up for Part A and/or Part B beginning one month after you lose group health plan insurance. You may also qualify for a Special Enrollment Period if you’re a volunteer, serving in a foreign country.

What is a Medicare Advantage Plan?

If you are in a Medicare Advantage plan, you would get both your Medicare Part A and Part B coverage through a private health insurance company contracted with Medicare. By law, Medicare Advantage plans must offer at least the same level of coverage as Original Medicare, and some plans include additional coverage not covered by Original Medicare, like routine dental, vision, hearing, and even prescription drug coverage.

When Can You Make Changes to Your Medicare Advantage Plan?

You can make changes to your Medicare Advantage plan at any time during the annual election period, known as open enrollment. This lasts from October 15 through December 7 each year. The changes you make will take effect on January 1 of the following year.