Medicare Part B

What is Medicare Part B coverage?

Medicare Part B is medical insurance; coverage includes (but isn’t limited to) medically necessary doctor services, screenings, outpatient hospital care, and other services that Part A does not cover, such as some physical or occupational therapies and some home health care services. Part B covers durable medical equipment as well.

What does it cover?

A range of preventive treatments, tests, services, and supplies are covered by Part B.

Medicare Part B covers the following:

Preventive and diagnostic services

• Physical examinations
• Tests, labs and screenings
• Glaucoma screening once a year, if performed by an eye doctor who’s legally authorized to give this test in your state
• Bone mass measurement, every two years (or as medically necessary), if you’re at risk for osteoporosis
• Lab services such as blood tests or urinalysis
• Colorectal cancer screenings to find any pre-cancerous growths. If your doctor feels they’re necessary, tests may include any of the following: annual fecal occult blood test, flexible sigmoidoscopy (every four years), screening colonoscopy (every ten years), and/or barium enema (every four years).
• Diabetic screenings, if you have high blood pressure, dyslipidemia, obesity, or high blood sugar
• Diabetic supplies, such as monitors, test strips, lancet devices, and therapeutic shoes
• Diabetic self-management training
• Cardiovascular screenings to help prevent heart attack or stroke. A screening consists of testing your triglyceride, lipid, and cholesterol levels every five years.

Doctors’ services don’t include routine physical exams except the one-time “Welcome to Medicare” exam. You can get this free exam from a Medicare-assigned doctor during the first 12 months you’re enrolled in Part B.

Doctor, hospital, and home health care

• Home health services (usually short-term), including limited reasonable and medically necessary part-time care and services such as skilled nursing care, physical or occupational therapy, home health aide services, speech language pathology, and medical social services
• Certain medical equipment used at home, such as wheelchairs, hospital beds, walkers, and oxygen equipment
• Certain medical supplies, such as (but not limited to) continuous positive airway pressure (CPAP) devices, oxygen, and oxygen equipment
• Chiropractic services, if the purpose is to correct one or more of the bones that has moved out of place in your spine (subluxation)
• Ambulance services, if any other form of transportation would endanger your health
• Blood (pints) that you receive during an outpatient visit or another Part B covered service
• Clinical trials, if your doctor decides a trial will help to diagnose, prevent, or treat diseases
• Ambulatory surgery center fees for approved services
• Emergency room services for bad injuries, severe illness, or any time you believe your life is in danger
• One pair of eyeglasses and standard frames after cataract surgery

Preventive Shots

• Flu shots are covered one time per year during flu season.
• Three hepatitis B shots are covered if you’re at medium or high risk for the disease.

Additional services covered include, but are not limited to:

• Hearing and balance exams
• Mammograms
• Dialysis
• Pap tests or pelvic exams
• Mental health care
• Medical nutrition therapy
• Hospital services
• Occupational therapy
• Outpatient surgery service and supplies
• Limited prescription drugs
• Practitioner services
• Physical therapy
• Prosthetic devices
• Transplant services

Part B premiums

You’ll typically pay a premium for Medicare Part B. Because of this, you have the option of turning it down, although you might pay a late enrollment penalty if you decide to join Medicare Part B later on. Also, you must have Part B if you decide to enroll in a Medicare Advantage plan.

You can also check to see if you’re qualified to receive help from your state to help you pay for premiums or deductibles. Otherwise, the premium is usually deducted from a Social Security, Railroad Retirement, or Civil Service Retirement check. You can also choose to pay the Part B premium quarterly, through the electronic payment option, or through Medicare Easy Pay.

Overall, Part B provides coverage to help minimize your health care insurance worries. Still, it doesn’t cover everything; for example, routine dental care isn’t covered, but some private Medicare plans may offer this coverage. Whatever health-care insurance coverage you choose, make sure you have a clear understanding of options, coverage, and premiums.

Medicare has neither approved nor endorsed this information.