What You Need to Know about Medicare Part B

The two main parts of Original Medicare are Part A (hospital insurance) and Part B (medical insurance). Any senior who qualifies for Medicare is eligible for Part B benefits, and the vast majority of seniors choose to enroll. If you are new to Medicare or just getting ready to transition to Medicare, you may have several questions about Part B benefits.


We hope to provide some answers here. Please feel free to reach out to one of our knowledgeable Medicare agents with any further questions about your Medicare coverage. We are here to help!

What You Need to Know about Medicare Part B


Should I sign up for Medicare Part B?


Seniors benefit from the medical insurance that comes with Medicare Part B. Medically-necessary health care such as doctors’ visits and tests, outpatient care, durable medical equipment, preventative care, home health care and other medical services are included in Part B.


While almost all seniors are eligible for premium-free Part A benefits, Medicare Part B does come with a monthly premium. The premium is based on your modified adjusted gross income (MAGI). If your MAGI is less than or equal to the “higher-income” threshold, you pay the “standard” Medicare Part B rate. In 2021 that rate is $148.50 a month. Seniors with low-income and low resources may qualify for a reduced or free monthly premium.


Ideally, seniors should sign up for Part B when they first become eligible. If you wait until the month you turn 65 or the three months after your 65th birthday to enroll, your Part B coverage will be delayed. This means that you could experience a gap in health coverage and you may even be assessed a late enrollment penalty.


According to AARP, the vast majority of people (93 percent) enroll in both Medicare Part A and Medicare Part B. Only six percent of eligible seniors enroll in Part A only and one percent enroll in Part B only.


Do I need Medicare Part B if I have other insurance?


It depends on your situation but generally speaking, seniors with other creditable coverage provided by an employer have the option to postpone Part B benefits without penalty.


Creditable coverage scenarios include:

  • Seniors who are still employed and have group health coverage

  • Seniors with a spouse who is still employed that has group health coverage

  • Seniors with their own or access to their spouse’s retiree group health coverage

  • Active-duty service members with TRICARE coverage

Any kupuna who do not fall into one of these categories should sign up for Medicare Part B as soon as they are eligible to avoid a lapse in health coverage and a late enrollment penalty.


Even if you do have other insurance, keep in mind that it can still be beneficial to have Part B benefits. The reason is that Medicare can act as a secondary payer to help cover some or all of the costs that your other insurance does not cover. In other scenarios, your employer insurance may be the secondary payer, and you may need to enroll in Medicare Part B before your private insurance will pay. It is always best to discuss your specific situation with your plan administrator.


What do I need to do if I do not want Medicare Part B?


If you decide to drop Part B after carefully reviewing your particular situation and all your options, there are some steps you must take depending on whether or not your Medicare has started.


If you are signed up but your Medicare has not started yet, you will fall into one of two categories.


1. If you were automatically enrolled in both Medicare Part A and Part B and you were sent a Medicare card, follow the instructions that come with the card and send the card back. If you hold onto the card, you will start getting billed for Part B premiums.


2. If you signed up for Medicare through the Social Security Administration, contact Social Security for help canceling Part B.


If your Medicare benefits have already started you will need to contact Social Security to get instructions on how to submit a signed request to their office to drop coverage. Once your request is received, your Part B coverage will end the first day of the next month.


Contact a PBC Agent for Help


Our independent insurance agents are dedicated to assisting people on Medicare and those who are ready to transition from employer coverage to personal retirement coverage. We help kupuna understand their benefits options and apply for additional coverage, as needed. Because we represent all the major Medicare Advantage and supplement plans in Hawaii, we are able to offer unbiased advice; all at no cost to our clients.


At PBC, our clients are our number one priority and we look forward to getting to know you and your needs. Call us today at (808) 738-4500 to see how we may be of assistance.