What Happens If I Don’t Enroll in Medicare Part B?

Feb 9, 2023

Anyone aged 65 or older and some younger people with disabilities and permanent kidney failure qualify for the Medicare health insurance program. The program aims to help with healthcare costs but does not cover all expenses or most long-term care costs.

Even though Medicare helps with the cost of health care, it won’t cover all medical expenses or the cost of most long-term care. However, there are choices on how to get Medicare coverage. Those with original Medicare (Part A and Part B) coverage can buy supplemental coverage, known as Medigap, from a private insurer.

Medicare Part B covers necessary medical services and items not covered by Medicare Part A. These include doctors, outpatient care, and other medical and preventative services (exams, lab tests, and other screenings to prevent, find or manage health problems).

Knowing how the system works, especially Medicare Part B, can help you understand what would happen if you didn’t join Medicare Part B.

At the Modern Medicare Agency, we feel it’s important that you completely understand Medicare and its Parts. So in this article, we will expand on Medicare Part B enrollments, costs, and coverage. We also explain what you can do if you want to enroll later.

Understanding Medicare Parts

Everyone enrolls in Medicare Part A and Part B through social security. Any other insurance linked to Medicare, also known as supplemental coverage or Medicare Advantage Plans, takes place through private insurance companies, but these insurance providers must follow ‌ Medicare rules.

Medicare Part A provides hospital insurance. It helps pay for hospital inpatient care and limited stays in a skilled nursing facility after a hospital stay. Part A will also pay for limited home health care and hospice care.

Medicare Part B provides medical insurance. It helps pay for doctor services, other health care providers, outpatient and home health care, and durable medical equipment. It also pays for some preventative tests.

The Modern Medicare Agency

Copyright: The Modern Medicare Agency

How Much Does Medicare Part B Cost?

Most people aged 65 onwards are eligible for free Medicare Part A if they have worked and contributed enough Medicare taxes to qualify. However, when signing up for Medicare Part B, they pay a standard monthly premium of $164.90 for 2023.

You pay the standard premium if you enroll for the first time in 2023, don’t get any social security benefits, and get billed directly for the premiums. You also pay the standard monthly premium if you have Medicare and Medicaid, and Medicaid will pay it.

However, suppose you have a higher income; you may pay a higher premium for your Medicare Part B, depending on the IRS’s most recent federal tax return to Social Security. It is known as the income-related monthly adjustment amount.

How Does Plan B Work?

Part B contributes towards doctors’ services and outpatient care while covering other medical services, like physical therapy, occupational therapy, and home health care. The government pays about 75% for most beneficiaries of the Part B premium, with the beneficiaries paying 25%.

However, higher-income beneficiaries pay a more significant percentage of the total cost based on ‌income reported to the IRS, with an increased monthly premium of 35 to 85%.

Why Do You Need Medicare Part B?

Medicare Part B covers medically necessary services to diagnose or treat a medical condition and preventative services to prevent or detect illnesses at an early stage when treatment is most effective.

Therefore, Part B provides supplemental coverage for a long list of medical services necessary to diagnose, detect, and treat medical conditions and illnesses. Services by doctors, ambulance, emergency services, and occupational therapy fall under Part B, as does clinical research studies and durable medical equipment (walkers, etc.).

There is also a range of screenings for aneurysms, clinical laboratory testing, bone density measurements, various cancers, cardiovascular screenings, EKGs, etc. There are also rehabilitation services, such as cardiac and pulmonary rehabilitation. In addition, it provides limited chiropractic services, prescription drugs, and eyeglasses.

Its cover for diabetes is comprehensive and includes screenings, self-management, supplies, and foot exams and treatments.

Besides covering Flu, Pneumococcal, and Hepatitis B shots, Part B also covers HIV screening, glaucoma testing, kidney dialysis, transplants, and immunosuppressive drugs.

Enrollment in Medicare Part B

You can sign up online for Medicare Part A and Part B by filling out the social security application. All eligible Americans can take advantage of the Initial Enrollment Period (IEP) that starts three months before they turn 65 and ends three months after their 65th birthday. Part B has a premium; you can turn it down if you don’t want it.

Your Medicare Part B coverage start date will depend on the date  ‌you are eligible for. Therefore, it works as follows:

  •       If you sign up one to three months before turning 65, your coverage starts on the  1st of the month you turn 65.
  •       If you enroll in the same month as your 65th birthday, your coverage will start one month after your birthday.
  •       If you sign up a month after turning 65, your coverage begins the month after your enrollment.
  •       If you enroll in the second or third months after your 65th birthday, your coverage starts the month after your enrollment.

Changes to Medicare Part B Coverage for 2023 onwards:

The enrollment rules for Part B coverage will change from 2023 onwards. If you accept automatic enrollment or sign up one to three months before turning 65, your Medicare Part B coverage starts the month you turn 65. If you sign up at any time in the month you turn 65, and within three months, your coverage begins the first day of the following month.

Can You Decide to Sign Up Later?

If you have chosen not to enroll for Medicare Part B but change your mind later, then expect that you may have a delay in your coverage and may even have a higher monthly premium for the duration of your Part B.

Your monthly premium increases by 10% every 12 months you were eligible but didn’t enroll. However, this won’t apply if you qualify for a Special Enrollment Period (SEP).

If you choose not to enroll for Medicare Part B during your IEP, you can sign up within the General Enrollment Period (GEP) between January 1 and March 31. Your coverage will start on the first day of the following month.

Who Qualifies for the Special Enrollment Period (SEP)?

Anyone with medical insurance coverage under a group health plan with 20 or more covered employees based on their or their spouse’s current employment may not need to apply for Medicare Part B at age 65.

These people may qualify for an SEP that allows them to sign up for Part B during the following:

  •       Any month they remain covered under the group health plan while their or their spouse’s employment continues.
  •       Within the eight months that begin with the month after their group health plan or the employment coverage plan it’s based on ends, whichever   comes first.

Bottom Line

Original Medicare and its components have several complexities and often lead to participants seeking supplemental coverage and other insurance. At The Modern Medicare Agency, we care that you understand the different coverages of basic Medicare, including Part B, by providing you with online resources and help from our knowledgeable team.