According to the Social Security Administration (2014b), anyone who is eligible for premium-free part A can enroll in Part B with a monthly premium. If you are not eligible for premium-free Part A, you can receive Part B if you are a U.S. citizen or “a lawfully admitted non-citizen who has lived in the United States for at least five years” (p. 7). Medicare Part B is completely voluntary and not funded by payroll taxes; therefore, enrollees must pay a monthly premium. These premiums are typically deducted from the enrollee’s Social Security check, unless there is a special circumstance (i.e. the beneficiary does not receive Social Security payments or the Social Security payment is lower than the cost of the Part B premium). The premium is determined by the Office of the Actuary each year to cover 25% of Part B costs, while 75% of the costs are paid for through general revenues (Learn about, 2012; SSA, 2013; Van de Water, 2013). These premiums are deposited into the Supplemental Medical Insurance (SMI) Trust Fund, which also receives a small amount of financial from special payments by states and from prescription drug manufacturer fees (Lew et al., 2014).
Original Medicare Part B “helps cover medically necessary doctors’ services, outpatient care, home health services, durable medical equipment, and other medical services” (DHHS, 2014, p. 40). Most preventive services are also covered, including a “wellness screening” once per year. If you have Original Medicare, you are required to pay the Part B deductible, which is $226 per year in 2023. After that, you typically pay 20% of the cost of the service. Wellness visits do not require a deductible or copay. During the first year of having Part B, you can have a “Welcome to Medicare” preventive visit that includes a review of your medical history, as well as education and counseling about preventive services. After that you can receive an annual wellness visit that includes a “Health Risk Assessment”. This visit is only covered once every 12 months (DHHS, 2014).
Beginning in 2023, certain Medicare enrollees who are 36 months post kidney transplant, and therefore are no longer eligible for full Medicare coverage, can elect to continue Part B coverage of immunosuppressive drugs by paying a premium. For 2023, the immunosuppressive drug premium is $97.10.
There are a variety of services covered by Part B; however, there is also a lot that is not covered. These health services include most dental care; eye exams related to prescribing glasses; dentures; cosmetic surgery; acupuncture; hearing aids and exams to fit hearing aids; and long-term care (DHHS, 2014). Many people who want these additional services or who want to pay lower deductibles and copays will purchase Medicare Advantage or Medigap.
Part B premiums for Original Medicare are the same for most people; however, if you have a higher income, your premium is higher. The income amount used to determine your premium is based on two years earlier. In other words, your 2021 income is used to determine your 2023 re shown below.
Adjustment Amount (IRMAA). IRMAA is an extra charge added to your premium.
IRMAA is an extra charge added to your premium.
|If your yearly income in 2021 (for what you pay in 2023) was||You pay each month (in 2022)|
|File individual tax return||File joint tax return||File married & separate tax return|
|$97,000 or less||$194,000 or less||$91,000 or less||$164.90|
|above $97,000 up to $123,000||above $194,000 up to $246,000||Not applicable||$230.80|
|above $123,000 up to $153,000||above $246,000 up to $306,000||Not applicable||$329.70|
|above $153,000 up to $183,000||above $306,000 up to $366,000||Not applicable||$428.60|
|above $183,000 and less than $500,000||above $366,000 and less than $750,000||above $97,000 and less than $403,000||$527.50|
|$500,000 or above||$750,000 and above||$403,000 and above||$560.50|
The 2023 Part B total premiums for high-income beneficiaries with immunosuppressive drug only Part B coverage are shown in the following table
|Part B Immunosuppressive Drug Coverage Only|
|Beneficiaries who file individual tax returns with modified adjusted gross income:||Beneficiaries who file joint tax returns with modified adjusted gross income:||Beneficiaries who are married and lived with their spouses at any time during the year, but who file separate tax returns from their spouses, with modified adjusted gross income:||Income-Related Monthly Adjustment Amount||Total Monthly Premium Amount|
|Less than or equal to $97,000||Less than or equal to $194,000||Less than or equal to $97,000||$0.00||$97.10|
|Greater than $97,000 and less than or equal to $123,000||Greater than $194,000 and less than or equal to $246,000||Not Applicable||$64.70||$161.80|
|Greater than $123,000 and less than or equal to $153,000||Greater than $246,000 and less than or equal to $306,000||Not Applicable||$161.80||$258.90|
|Greater than $153,000 and less than or equal to $183,000||Greater than $306,000 and less than or equal to $366,000||Not Applicable||$258.90||$356.00|
|Greater than $183,000 and less than $500,000||Greater than $366,000 and less than $750,000||Greater than $97,000 and less than $403,000||$356.00||$453.10|
|Greater than or equal to $500,000||Greater than or equal to $750,000||Greater than or equal to $403,000||$388.40||$485.50|