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Medicare Part B – enrollee benefits and coverage costs
Medicare Part B provides coverage of services provided by doctors, outpatient hospital services and other healthcare providers, as well as some home health services and durable medical equipment.
The Medicare Part B special enrollment period
The Medicare Part B SEP allows people to delay Part B enrollment if they have health coverage through their own employer or a spouse’s current employer.
Four ways to save money on your Medicare Part B premiums
Here's how to save money on premiums for Medicare Part B – which covers doctor visits, diagnostics, and preventive care.
Three Medicare open enrollment mistakes to avoid at all costs
Can't wait to make changes to your Medicare coverage during open enrollment? Just know that open enrollment can also be an occasion for major enrollment blunders. Here are three that you'll want to steer clear of.
During the annual Medicare open enrollment period, you’ll likely see commercials for a “giveback” or “premium reduction” rebate that will reduce the amount you have to pay for Medicare Part B. Here’s what you need to know about how this works:
Most Medicare beneficiaries qualify for premium-free Medicare Part A, based on their work history or their spouse’s work history. But Medicare Part B has a monthly premium, which is $164.90/month for most beneficiaries in 2023.
If you choose to enroll in a Medicare Advantage plan, you pay the premium for Part B plus the premium for the Advantage plan. As of 2023, two-thirds of all Advantage plans have $0 premiums, which means their enrollees just pay the Part B premium.
But some of those plans go a step further, offering “giveback” rebates that pay a portion of their enrollees’ Part B premiums. This benefit, also referred to as a Medicare Part B premium reduction, has been available since 2003. And although most Advantage plans do not offer a giveback rebate, the benefit has become more popular and widespread in recent years, and is increasingly marketed as a stand-out benefit by Medicare Advantage plans that do offer it.
The specifics of the giveback rebate rules are outlined in federal regulations that have been applicable since Medicare+Choice plans were rebranded as Medicare Advantage. Medicare Advantage plans receive payments from the federal government (which cost the government more per person than it spends on Original Medicare). But the plan can opt to receive a reduced payment and use the payment reduction to offset some of the Part B premium for its enrollees.
For plans that take this option, the Part B premium reduction can be as little as 10 cents, or as much as the full Part B premium, which is $164.90/month in 2023. The Part B premium reduction has to be provided uniformly to a plan’s enrollees, so everyone in the plan gets the same Part B premium reduction.
For most Medicare beneficiaries, the cost of Part B is deducted from their Social Security checks. Beneficiaries who don’t receive Social Security retirement benefits are invoiced directly for their Part B premiums. The giveback rebate can be used by people in either scenario: If you’re receiving Social Security retirement benefits and you enroll in an Advantage plan with a giveback rebate, the amount that’s deducted from your check to cover the cost of Part B will be lower. And if you pay your premiums directly to Medicare, you’ll be invoiced a smaller amount.
The commercials for Medicare Advantage giveback rebates are aired nationwide, although plans that offer this benefit are not available in all areas. But giveback rebates have become more common in recent year, and most areas of the country do have at least one Medicare Advantage plan that offers this benefit as of 2023. However, even if you’re in an area where this benefit is offered by at least one Advantage plan, it’s likely that the majority of the available plans will not offer it.
Assuming there are Medicare Advantage plans in your area that offer a giveback rebate, it’s important to evaluate all of the available plans based on how they’ll serve your overall needs. If a plan has a $50 giveback rebate but will end up costing you an extra $60 every month at the pharmacy, or doesn’t include your doctors in its network, it’s probably not going to be your best option.
CMS is looking into the marketing around giveback rebates, and addressed it in proposed rulemaking that was issued in late 2022. CMS notes that the nationwide marketing of giveback rebates equal to or near the full amount of the Part B premium is a “misleading tactic that is more likely designed to attract a beneficiary’s attention so that the beneficiary will call the number and then be subject to additional marketing and potentially switched to a plan that is not well suited to meet the beneficiary’s health care needs.” Specifically:
To address these issues, CMS has proposed that Medicare Advantage and Part D insurers “may not engage in marketing that advertises benefits that are not available to beneficiaries in the service area where the marketing appears unless unavoidable in a local market.” If finalized, this would take effect in 2024.
For now, if you’re seeing marketing for significant giveback rebates, be aware that these benefits may or may not be available in your area, and that the plans offering them may or may not be the option that works best for your particular needs.
When you’re comparing plans on the Medicare Plan Finder tool, you can click on “plan details” to see more information about each plan. An overview page will appear, and the section at the top is all about premiums. The fourth line is labeled “Part B premium reduction” and it will either say “yes” or “no” depending on whether the plan offers a Part B giveback rebate. You can also call the Medicare Advantage insurers in your state to ask them directly about whether they offer this benefit.
The total monthly premium is just one aspect of your coverage, and there are numerous other features that you’re going to want to take into consideration when you’re making a plan selection. For example:
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.