MEDICARE (PART B): OUT OF POCKET COST
What is Medicare Part B?
Medicare Part B covers physicians’ services, outpatient hospital services, certain home health services, durable medical equipment, and certain other medical and health services not covered by Medicare Part A.
Enrollment
There are three times you can enroll for Medicare:
1. Initial Enrollment - The initial enrollment period begins 3 months before you turn 65 and last until 3 months after you turn 65 (for a total of 7 months). For retirees that are not covered under an employer plan, enrolling in Medicare Part B during this period is typically advantageous.
2. Special Enrollment - For employed individuals covered under an employer plan, or for individuals that missed the Initial Enrollment period, it is generally a good strategy to enroll during the Special Enrollment period. There are a wide variety of Special Enrollment situations, which can be found here, but the most common by far is if you had a job that provided you health insurance coverage.
In this situation, you can enroll in Medicare Part B anytime from when your Initial Enrollment period ends, or up to 8 months after your employment or coverage ends, whichever comes first.
3. General Enrollment - You can sign up between January 1-March 31 each year. This is called the General Enrollment Period. Your coverage starts the month after you sign up. You might pay a monthly late enrollment penalty, if you don’t qualify for a Special Enrollment Period.
Coverage & out of pocket costs
The out-of-pocket costs for Medicare Part B can be nuanced, but in general there are two 'buckets' that must be calculated to determine plan participants out of pocket cost: the deductible and coinsurance.
Deductible: For the year 2024, the deductible is set at $240.
Coinsurance: Generally, after the deductible is paid, Medicare will pay 80% of additional expenses and the plan participant is responbile for the remaining 20%.
Full Part B Coverage
Beneficiaries who file individual tax returns with modified adjusted gross income:
Less than or equal to $103,000
Greater than $103,000 and less than or equal to $129,000
Greater than $129,000 and less than or equal to $161,000
Greater than $161,000 and less than or equal to $193,000
Greater than $193,000 and less than $500,000
Greater than or equal to $500,000
Beneficiaries who file joint tax returns with modified adjusted gross income:
Less than or equal to $206,000
Greater than $206,000 and less than or equal to $258,000
Greater than $258,000 and less than or equal to $322,000
Greater than $322,000 and less than or equal to $386,000
Greater than $386,000 and less than $750,000
Greater than or equal to $750,000
Income-Related Monthly Adjustment Amount
$0.00
$69.90
$174.70
$279.50
$384.30
$419.30
Total Monthly Premium Amount
$174.70
$244.60
$349.40
$454.20
$559.00
$594.00
Calculator
Explore the Medicare Part B Out-of-Pocket Cost Calculator to understand potential expenses for medical expenses ranging from out patient surgery to purchasing medical equipment. This tool offers estimates based on current Medicare rates and coverage guidelines.
The calculators on the site provide a high level overview of your financial picture. For comprehensive planning, schedule a meeting.
