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Medicare provides essential healthcare coverage for individuals aged 65 and older, as well as those with certain disabilities. While Medicare Part A is free for enrollees, it’s Medicare Part B that is typically not free and most beneficiaries need to pay a premium in order to have this in place.
So can you get Part B free? In this guide, we’ll delve into the details of free Medicare Part B coverage, eligibility requirements, and the application process. We will also address some common questions to help you navigate the Medicare landscape.
Eligibility for Free Medicare Part B Coverage
Part B Eligibility
To be eligible for free Medicare Part B you must first be eligible for Medicare Part B itself by meeting one of the following criteria.
A. Age-based eligibility: To be eligible for free Medicare Part B coverage, individuals must meet specific criteria based on age. For those aged 65 and older, enrollment in Medicare Part B is generally automatic.
B. Disability-based eligibility: Qualifying for Medicare due to disability entails meeting specific criteria established by the Social Security Administration (SSA). If you are under 65, you may eligible fo Medicare if you meet the criteria for qualifying disabilities. SSA evaluates the severity and duration of your disability to determine eligibility for Medicare benefits. Some key points that people with disability need to consider are:
- Duration of disability: To qualify for Medicare due to disability, your condition must last for at least 12 consecutive months.
- Social Security Disability Insurance (SSDI): If you receive Social Security Disability Insurance (SSDI) benefits, you are automatically eligible for Medicare after a waiting period of 24 months.
- Supplemental Security Income (SSI) and Medicare: Individuals who receive Supplemental Security Income (SSI) benefits based on disability may also be eligible for Medicare.
Qualifying for Free Medicare Part B
To qualify for free Medicare Part B you must qualify based on limited income and resources under the Medicare Savings Program. Eligibility for the Medicare Savings Program depends on factors such as age, disability status, income, and assets. Let’s look at them one by one.
1. Income-based eligibility: Income plays a crucial role in determining eligibility for free Part B coverage. To qualify, individuals must meet specific income requirements. The income thresholds update annually based on the federal poverty level (FPL) guidelines. As of November 2023, the income limits for free Part B coverage are as follows:
- Individuals with an income at or below 135% of the FPL: Individuals whose income falls at or below this threshold may qualify for free Part B coverage. As of now, the income limit for an individual is $1,640 per month or $19,683 per year.
- Married couples with a combined income at or below 135% of the FPL: Married couples living together and applying for free Part B coverage may qualify if their combined income is below a particular threshold. As of now, the income limit for a married couple is $2,219 per month or $26,622 per year.
To assess income eligibility, Medicare considers Modified Adjusted Gross Income (MAGI), which provides a more accurate reflection of an individual’s financial situation. MAGI takes into account the following components:
- Adjusted Gross Income (AGI): AGI calculations take an individual’s total income before subtracting certain deductions. The sources of income are wages, self-employment earnings, rental income, and investment income.
- Tax-exempt interest: This refers to interest earned on certain types of investments that are exempt from federal income tax, such as municipal bonds.
- Non-taxable Social Security benefits: MAGI includes Social Security benefits that are not subject to federal income tax.
- Deductions: Certain deductions, such as contributions to retirement accounts (traditional IRAs and 401(k) plans) and student loan interest are subtracted from AGI to arrive at MAGI.
2. Asset-based eligibility: Assets also play a role in determining eligibility for free Part B coverage. Medicare considers certain assets such as savings accounts, investments, and real estate to assess eligibility.
Medicare sets specific asset limits to determine eligibility for free Part B coverage. These limits are subject to change annually based on federal poverty level guidelines. As of now, individuals with assets below $9,090 and couples with assets below $13,630 are generally eligible for free Part B coverage.
Please note that not all assets count toward the asset limits. Medicare excludes certain assets from consideration, including:
- Primary residence: The value of your primary residence is generally excluded from the asset calculation. That means the value of your home is not counted to determine free Part B eligibility.
- Personal belongings and household items: Medicare does not count the value of personal belongings such as furniture, appliances, and clothing, or household items toward asset limits.
- One vehicle: The value of one car is typically excluded from the asset calculation. This exemption ensures that individuals can maintain personal transportation for essential needs.
- Burial plots: Asset limits also do not include the value of burial plots, prepaid funeral arrangements, or funds set aside for funeral expenses. This exemption recognizes the importance of ensuring dignified end-of-life arrangements.
- Life insurance policies: The cash value of life insurance policies is generally not counted toward asset limits. There may, however, be certain restrictions or limitations depending on the policy.
If you are below the thresholds mentioned above for income-based and asset-based eligibility the Medicare Savings Program may help pay for your Part B premium and in some cases your Part B deductible and copays/coinsurances as well.
Applying for Free Medicare Part B Coverage
Medicare Savings Programs are Medicaid-administered, therefore you’ll apply for Medicare Savings Programs through your state. When you apply, your state determines which program(s) you qualify for.
Importantly, you do not need to have Medicaid to apply for MSPs. Even if you don’t think you qualify, you should still apply as there may be exceptions that still allow you to be eligible.
Being under an MSP program also automatically qualifies you for Extra Help (also called ‘Low Income Subsidy’), the federal program that pays prescription drug costs for low-income Medicare beneficiaries.
At CoverRight, we work hard to help you make informed decisions about all aspects of your Medicare coverage. Our team of experts is here to provide personalized guidance and support as you navigate the complexities of free Medicare Part B.
Contact us today to gain a clear understanding of your eligibility, learn about the application process, and ensure you access the essential medical services covered by Medicare Part B.
Frequently Asked Questions (FAQs)
What are the differences between Medicare Part A and Part B?
Medicare Part A, also known as Hospital Insurance, covers inpatient hospital stays, skilled nursing facility care, hospice care, and limited home health services. Medicare Part B, or Medical Insurance, covers outpatient medical services, including doctor visits, preventive care, medical supplies, and durable medical equipment.
Can I have both Medicaid and free Part B coverage?
Yes, it is possible to have both Medicaid and free Part B coverage. In fact, when you are on Medicaid, your Medicaid will help cover the healthcare costs that Medicare doesn’t fully address including your Part B premium.
Will I be automatically enrolled in Part B if I have Part A?
If you’re getting benefits from Social Security (or the Railroad Retirement Board) at least 4 months before you turn 65, you’ll automatically get Part A coverage. You’ll also be signed up for Part B (unless you live in Puerto Rico or outside the U.S.). If you are not receiving Social Security benefits at least 4 months before you turn 65, you will need to proactively enroll in Medicare by contacting Social Security.
What happens if I don’t enroll in Part B during my Initial Enrollment Period (IEP)?
You may face late enrollment penalties if you don’t enroll in Medicare Part B during your Initial Enrollment Period. These penalties can result in higher premiums for the entire duration of your Medicare coverage. However, if you qualify for the Medicare Savings Program and/or your state’s Medicaid program penalties may be waived.
