A detailed look at what’s covered under Medicare Part B
Original Medicare consists of two parts provided by the federal government: Medicare Part A and Medicare Part B.
Medicare Part A is hospital insurance that covers inpatient care in a hospital, skilled nursing facility care, nursing home care, hospice, and some home health care.
Medicare Part B is medical insurance that helps cover outpatient care, such as doctor’s visits and lab testing. It also covers preventive care such as flu shots, colonoscopies, and mammograms.
Medicare Part B has a monthly premium, which is typically deducted from your Social Security benefits. In some cases, such as when you visit your doctor, there is a deductible, and you pay some cost sharing.
So, what does Medicare Part B cover and not cover when it comes to your health?
What Medicare Part B covers
Medicare Part B helps cover certain medically necessary services, such as doctor visits and tests, outpatient care, home health services, and durable medical equipment (DME).
Preventive services: This is care to help prevent illness and detect a condition or sickness at an early stage. Services include lab tests, surgeries, annual wellness exams, screenings, and yearly flu shots.
See a full list of covered preventive services at Medicare.gov.
Doctor/clinic care: If you’re sick or have a medical condition, Medicare Part B helps cover doctor’s visits and care. This includes any outpatient service you receive in your doctor’s office or in a clinic. Some inpatient services in a hospital are also covered.
Home health services: These are treatments provided in your home if you’re sick or injured. When possible, they help patients regain independence and self-sufficiency. Coverage includes part-time skilled nursing care as well as physical and occupational therapy.
Medicare Part B also helps cover clinical trials; ambulance services; durable medical equipment such as wheelchairs; blood sugar test strips; crutches; mental health services; partial hospitalization; and some outpatient prescription drugs. It can also cover trips to the emergency room (ER) if you have an injury, a sudden illness, or an illness that quickly gets much worse. You may not be covered if you make an ER visit for a non-emergency.
See which tests, items and services are covered under Medicare Part B.
What Medicare Part B does not cover
Medicare Part B does not cover a number of services, including hospital expenses (which are typically covered by Medicare Part A) and prescription drugs.
Cosmetic procedures and routine dental, vision, hearing, and foot care are also not typically covered under Medicare Part B. This includes eye exams, hearing aids, and dentures. If you want coverage for this kind of care, you’ll need to consider standalone plans, like Medicare Part D for prescription drug coverage and dental plans. Long-term care is also not covered.
Still wondering what Medicare Part B covers and does not cover? Talk to your doctor or healthcare provider so they can help you understand why you need certain tests, items, or services and whether Medicare will cover them.
FAQs
Q1. Do I have to pay for Medicare Part B?
Yes, you have to pay a monthly premium for Medicare Part B services. Medicare Part B also includes an annual deductible that you will need to reach in full each year before Medicare picks up the cost of the health care services.
Q2. What does Medicare Part B cost per month?
The cost for Medicare Part B includes a monthly premium that is based on your annual income. Your tax filing status – single, married filing jointly, married filing separately, head of household, or qualifying surviving spouse – also factors in on your cost for Medicare Part B. These costs can change annually.
Q3. Do I need both Part A and Part B?
It’s usually a good idea to carry both Medicare Part A and B because each plan covers different healthcare services you may need. While Medicare Part B covers your general health care needs, including doctor visits, outpatient care, and preventive services, Medicare Part A helps cover the cost of inpatient hospital stays, skilled nursing facility care, and hospice care, which is helpful if and when you need it.
Q4. Does Medicare Part B cover prescriptions?
Medicare Part B does help cover some prescriptions, but that coverage is limited to certain medications that are administered in a clinical setting, such as a doctor’s office or outpatient facility. Examples of medications covered by Medicare Part B include specific cancer treatments, injectable medications, and drugs used with durable medical equipment (DME). For coverage of most prescription drugs, you’ll need to enroll in a separate Medicare Part D prescription drug plan.
Q5. What does Medicare not cover?
Original Medicare generally only covers up to 80% of your health care costs after you meet your Medicare Part B deductible. You are responsible for paying the remaining 20%.
Medicare Part A and B, known as Original Medicare, doesn’t cover most prescription drugs or services for dental, eye, and hearing care. For prescription drugs, If you decide you’d like coverage for these health services, you’ll need to consider a Medicare Part D plan or standalone dental, eye, and hearing care plans. You can also elect to enroll in a Medicare supplement insurance plan or Medicare Advantage, which can help cover additional costs outside of Original Medicare.
Q6. How do you apply for Medicare Part B?
There are several ways you can apply for Medicare Part B. If you are already receiving Social Security benefits, then you are automatically enrolled in both Medicare Part A and Part B once you turn 65. Otherwise, you are eligible to sign up during a 7-month period which begins three months before the month you turn 65, includes your birth month, and ends three months after your birth month. If you miss this Initial Enrollment Period, you can sign up during the annual General Enrollment Period, which runs from January 1 to March 31, but penalties may apply for missing your initial enrollment.
Sign up for the coverage is done through Social Security. You can enroll:
- Online at the Social Security website at ssa.gov,
- By phone at (800) 772-1213,
- In person at your local Social Security office, or
- By mail with Form CMS-40B.
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