Medicare B

Your Partner for Medical Services and Doctor Visits

If Medicare Part A is the roof over your head at the hospital, you can think of Medicare Part B as the coverage that keeps you healthy day-to-day. At Snowflake Health Insurance, I often describe Part B to my clients as their “Medical Insurance.” This is the part of Medicare that covers the services you use most frequently, such as doctor visits, outpatient surgeries, lab tests, and durable medical equipment. While Part A sits quietly in the background until an emergency happens, Part B is active in your everyday life, helping you manage chronic conditions and maintain your overall well-being.

Unlike Part A, which is usually premium-free, Medicare Part B comes with a monthly premium. The standard premium amount is set by the federal government each year, and it is the same for most people. However, if you have a higher income, you might pay an additional amount known as the Income-Related Monthly Adjustment Amount, or IRMAA. Conversely, if you have a limited income, there are state programs that can help cover this premium. Part of my service to you is helping you understand exactly what your premium will be so you can budget accordingly. We can look at your financial situation and ensure you aren’t paying more than you need to, or check if you qualify for assistance programs.

The scope of what Part B covers is quite broad. It includes medically necessary services and preventative services. Medically necessary services are what you need to diagnose or treat a medical condition. This includes your visits to a primary care doctor or a specialist, ambulance services, mental health care, and second opinions before surgery. It also covers durable medical equipment, which includes things like wheelchairs, walkers, and oxygen equipment. As we get older, these items become essential for maintaining independence, and knowing that Part B helps cover the cost is a huge relief for many of my clients.

Preventative services are a major component of Part B that I always encourage my clients to utilize. Medicare wants you to stay healthy because it is better for you and less expensive for the system. Therefore, Part B covers a wide range of screenings and shots at no cost to you. This includes your annual flu shot, screenings for diabetes, cardiovascular disease, and certain types of cancer, as well as your initial “Welcome to Medicare” visit. Taking advantage of these preventative measures is one of the best ways to protect your health, and I am always here to remind you of the benefits available to you.

One of the most critical things you need to understand about Part B is the cost-sharing structure. After you pay a small annual deductible, Medicare Part B generally pays 80% of the Medicare-approved amount for covered services. You are responsible for the remaining 20%. This is often referred to as the “80/20 rule.” While paying 20% for a doctor’s visit might not sound too bad, paying 20% of a complex surgery or chemotherapy treatment can be financially devastating because there is no cap on that 20% out-of-pocket cost under Original Medicare. This is usually the moment in our conversation where I explain why supplemental coverage is so important, but understanding the gap in Part B is the first step.

Enrollment in Part B is extremely time-sensitive. If you are already taking Social Security, you will be enrolled automatically. If not, you must sign up during your Initial Enrollment Period around your 65th birthday. If you miss this window and do not have other creditable coverage—like insurance from a current employer—you could face a late enrollment penalty. This penalty isn’t a one-time fee; it is added to your monthly premium for as long as you have Part B. I want to help you avoid that penalty. I work with you to determine exactly when you need to sign up and guide you through the process so you never have to worry about paying extra for the rest of your life.

There are also specific rules for people who are still working past age sixty-five. Many of my clients wonder if they need Part B if they still have insurance through their job. The answer depends on the size of the employer and how the plans work together. In some cases, delaying Part B is the smart financial move; in others, it is a mistake. I help you analyze your employee benefits alongside Medicare to make the decision that saves you the most money while keeping you fully protected.

Medicare Part B is essential for accessing the doctors and treatments you trust. It gives you the freedom to see any provider in the country who accepts Medicare, without worrying about referral networks. But it is complex, and the costs can be unpredictable if you don’t have the right guidance. At Snowflake Health Insurance, I am dedicated to making sure you understand how Part B works, how to maximize its preventative benefits, and how to protect yourself from the costs it leaves behind. Let’s make sure your medical insurance is working as hard as you do.