What Does Medicare Part B Cover?
Key Takeaways
- Medicare Part B provides the medical insurance portion of Original Medicare (Parts A and B)Original Medicare is a fee-for-service health insurance program available to Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance). .
- For Part B to cover your service or treatment, it must be either medically necessary or preventive.
- Medicare Part B generally covers 80% of medically necessary services. You’ll pay the leftover 20%, or coinsuranceCoinsurance is the percentage of your medical costs that you pay after you meet your deductible. Your insurance company pays the remaining amount. For example: If you have a $1,000 medical bill and your coinsurance is 20%, you’ll pay $200. Your insurance company will cover the final $800. .
- Part B coverage can also include benefits such as telehealth appointments, durable medical equipment and transportation in an ambulance.
Medicare Part B coverage can be complicated. Different types of treatments are covered at different levels, and sometimes not at all. Here’s what you need to know to use the part of Original Medicare that provides medical insurance.
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What Exactly Does Medicare Part B Cover?
Medicare Part B covers a long list of treatments, services and equipment. These can include everything from cancer screenings and treatments to motorized scooters. But for Part B to help, your treatment or service must be one of the following: Medically necessary These include treatments and services that are needed to diagnose or treat a health condition. Your doctor must certify they’re necessary. Preventive service Aimed at preventing illnesses, these covered services aim to find health conditions early on to improve patient outcomes. These include screenings and immunizations.Medicare Part B also covers some things you might not think of as traditional medical treatments. If your doctor determines the following are medically necessary, your Part B benefits can include:
- Doctor Services: Part B helps cover routine visits with your doctor, including check-ups and visits for referrals. Remember, visits for preventive care are often no-cost.
- Durable medical equipment: Medicare will cover a range of at-home equipment if your doctor certifies you need it. This can include wheelchairs, CPAP machines, blood sugar monitors, and more. Your durable medical equipment must be prescribed by a doctor and obtained through a Medicare-approved supplier.
- Outpatient therapies: Part B may cover mental health therapy and physical therapy when performed in outpatient or home settings. If your treatment requires inpatient care, it may be covered by Part A.
- Limited chiropractic care: If you suffer from a subluxation of the spine, Part B may cover treatments by a chiropractor. If your chiropractor orders additional testing such as X-rays, verify they will be covered by Part B. Part B will not cover routine chiropractic care.
- Ambulance services: Medicare Part B coverage includes trips in an ambulance to a hospital or other medical facility. For Part B to apply, transportation in a regular vehicle must endanger your health.
- Telehealth & telemedicine: If you have a two-way video device and your doctor allows e-visits, Part B may cover a remote doctor visit. Call your doctor for a list of services they can provide during a telehealth visit.
To find out if a service or benefit is covered, ask your doctor. They’ll be able to discuss your needs and determine what Medicare Part B will cover for you.
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What Services Does Medicare Part B Not Cover?
Medicare Part B covers a wide range of medical services, but not everything. If there’s a service or treatment you’d like to receive, but Medicare or your doctor don’t consider it medically necessary, you may have to pay for it yourself. Here’s a quick list of some of the things Medicare Part B coverage doesn’t include:- Cosmetic surgery
- Routine dental care
- Long-term care, also known as custodial care
- Dentures
- Eyeglasses
- Hearing aids
Does Medicare Part B Cover 100 Percent?
When it comes to preventive services such as screenings and the flu shot, Medicare Part B will cover 100% of your portion. That means you won’t have to pay a copayment or coinsurance, and the visit won’t count toward your Part B deductible.
If you receive medically necessary care, Medicare will generally cover 80% of your costs after you’ve paid your Part B deductible. You’ll be responsible for paying the remaining 20%. This is known as coinsurance. Medicare pays this portion for most of the Part B benefits that are covered, including durable medical equipment, ambulance transportation and doctor services.
While Part B doesn’t pay 100% of your medically necessary services, there are options to help with your costs. Medicare Supplemental Insurance, or Medigap, is a set of policies that help cover out-of-pocket costs from Medicare. Some Medigap plans will cover Part B costs like your deductible and coinsurance. If you have a limited income and resources, you may also qualify for financial assistance from a Medicare Savings Program.
Does Medicare Part B Cover Doctor Visits?
Yes, Medicare Part B coverage typically includes doctor visits to treat or prevent health conditions. These fall in one of two categories: Medically necessary or preventive. If your visit is solely for a preventive service, you generally won’t have to pay a copay or coinsurance when you’re done. If your stay is medically necessary, Medicare will pay for 80% of your costs once your deductible is paid. After that, you’ll pay 20% of the Medicare-approved costs for all services you receive.
Other Parts of Medicare may come into play during your visit. If you visit your doctor and are then admitted into a hospital, Part A may cover your facility-based costs. Suppose your doctor gives you certain vaccines, such as a Shingles vaccine. In that case, they may be covered by Medicare Part D. If you have questions about which Parts of Medicare apply to your services, check out our Medicare Coverages & Benefits guide, or ask your doctor for an explanation.
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Medicare Part B Costs & Enrollment
You’ve now answered the question, “What does Medicare Part B cover?” Getting that coverage to work for you, though, means you’ll need to understand some other key aspects of Medicare Part B. Medicare Part B has its own costs, and enrollment can vary from the other parts of Medicare. In other words, there’s more to cover than just Medicare Part B coverage.
What Does Medicare Part B Cost?
Medicare Part B covers most of your medical needs, and there are several different costs you will want to know about when you receive service. People often point to the monthly payment, or premium, as the cost of Medicare Part B. Instead, make sure to budget for coinsurance, deductibles, and more.
How to Enroll in Medicare Part B
The easy answer? Your first chance to enroll is a seven-month period around the day you turn 65. But that’s just the first of several opportunities you may have to enroll in Medicare Part B. There are several details to consider, including whether you’re still working and the size of your employer. Make sure you understand your decision — not enrolling when you’re first eligible can leave you paying monthly enrollment penalties for as long as you have Part B.
Do I need a referral to see a specialist with Medicare Part B?
No; as long as the specialist accepts Medicare, you should be covered. But that does not mean that every service ordered by a specialist will be covered. Sometimes, a doctor or provider may suggest a treatment or service that Medicare does not consider medically necessary or preventive. This can include cosmetic surgery and routine chiropractic care. To make sure your services are covered, ask your doctor to verify that Medicare will accept the charges for any treatments you receive. If Medicare doesn’t cover them, you may have to pay yourself.
Does Medicare Advantage provide Medicare Part B coverage?
Medicare Advantage (Medicare Part C) substitutes Original Medicare (Part A & B) and offers at least the same coverage. Medicare Part C often includes additional services.
Is Medicare Part B coverage the same across the country?
Yes; Original Medicare (Parts A and B) is a federal program, and the coverage and requirements for enrollment are the same across the U.S. Whether you live in Kansas, Kentucky or California, Medicare Part B coverage is the same.