What Does Medicare Part B Cover?

January 27, 2020

Medicare Part B is a type of insurance for medical care. It’s one half of Original Medicare, which is sometimes called Traditional Medicare. Part A makes up the other half.

Medicare Part B covers two main types of health care:

  • Preventive care: Health care that can either prevent a condition or illness or catch it early, when treatment is most effective
  • Medically necessary care: Health care meant to diagnose or treat a condition and can meet accepted medical standards

What it doesn’t cover, in brief, is inpatient hospital care (that’s Part A), most prescription drugs (that’s Part D), and things that employer-sponsored health insurance typically includes, such as dental and vision care.

We've gathered some common examples of what Medicare Part B covers (and doesn’t cover) so you know exactly what this means for you.

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What Medicare Part B covers: Preventive services

Medicare Part B covers the following preventative services, which are meant to keep you healthy or catch any emerging health issues early.

Checkups at your doctor’s office

  • A one-time “Welcome to Medicare” preventive visit (within the first 12 months you are on Part B)
  • Yearly "Wellness" visits (every year thereafter)

Both of these Medicare wellness visits are different from a complete physical exam, which Part B does not cover. Because wellness visits are meant to be strictly preventive, and additional tests like bloodwork (part of many physicals) stray into the realm of diagnosis, they are not covered as part of the visit. (If you request them, you may have to pay extra.)

Shots and vaccines

  • Flu/influenza (every year)
  • Hepatitis B (if you’re at medium or high risk)
  • Pneumonia/pneumococcal (if needed)

Other recommended adult immunizations, such as shingles or Tdap (tetanus, diphtheria, and pertussis), are covered by a Part D prescription drug plan.

Screenings for cancer

  • Breast cancer: Clinical breast exam every 24 months (as part of a pelvic exam); mammogram once every 12 months
  • Cervical and vaginal cancer: Pap tests and pelvic exams once every 24 months (or 12 months if you’re high risk)
  • Colorectal cancer: Multi-target stool DNA test, barium enema, colonoscopy, fecal occult blood test, flexible sigmoidoscopy (frequency varies depending on your age, risk level, and testing history)
  • Lung cancer: Low-dose computed tomography (LDCT) every 12 months
  • Prostate cancer screenings: Prostate-specific antigen (PSA) test and digital rectal exam once every 12 months

Screenings for other conditions

  • Abdominal aortic aneurysm: A one-time ultrasound for those at risk
  • Alcohol misuse: One screening per year
  • Cardiovascular disease: Electrocardiogram (ECG/EKG) as part of the “Welcome to Medicare” visit, blood tests (cholesterol, lipid, lipoprotein, and triglycerides) once every five years
  • Depression: One per year
  • Diabetes: Up to two per year
  • Glaucoma: Tests once every 12 months for those at high risk
  • Hepatitis B: Annually for those at high risk
  • Hepatitis C: Annually for certain people at high risk
  • HIV: Once every 12 months
  • Low bone density: Bone mass measurements once every 24 months
  • Obesity: Body mass index (BMI) calculation (at least every 12 months)
  • Sexually transmitted infections: Tests for chlamydia, gonorrhea, and syphilis once every 12 months

Counseling, behavioral therapy, and training

  • Alcohol misuse: Four face-to-face counseling sessions per year
  • Cardiovascular disease: One visit per year with a primary care physician
  • Diabetes: Outpatient self-management training (if you have diabetes) or diabetes prevention program (if you have pre-diabetes)
  • Nutrition therapy services: Three hours of one-on-one counseling the first year (two hours in subsequent years) if you have diabetes, have kidney disease, or had a kidney transplant in the last 36 months
  • Obesity: Face-to-face individual behavioral therapy sessions if you have a BMI of 30 or more (sessions are weekly for the first month, every other week for the next five months, then monthly for the next six months if you’ve lost at least 6.6 pounds)
  • Sexually transmitted infections: Up to two 20–30 minute, face-to-face, behavioral counseling sessions each year if sexually active and at increased risk
  • Smoking and tobacco use: Up to eight face-to-face visits in a 12-month period

What Medicare Part B covers: Medically necessary services

When you need care to diagnose or treat a medical condition, Part B covers the following:

Care from non-hospital locations

Part B covers care that you receive outside the hospital, which means these types of locations and services are covered:

  • Ambulatory surgical centers
  • Doctor and other health care provider services
  • Emergency departments
  • Federally Qualified Health Centers (FQHCs)
  • Home health services
  • Outpatient hospital services
  • Outpatient surgeries
  • Rural Health Clinics (RHCs)
  • Telehealth
  • Urgently needed care

Ambulance services

  • Ground transportation to the nearest appropriate medical facility that can treat your condition
  • Airplane or helicopter transportation may be covered if ground transportation can’t provide “immediate and rapid” access to a medical facility

Advance directive

Medicare will cover discussing and preparing an advance directive, which is a document you sign to share your wishes about medical treatment if you can’t communicate them in the future. It can be part of your yearly wellness visit or part of a specific medical treatment.

Blood

Blood transfusions are covered by Medicare, whether you need blood as a hospital inpatient (Part A) or outpatient (Part B).

Care management

  • Chronic care management services: Help from a health care provider to manage two or more chronic conditions such as arthritis, asthma, diabetes, hypertension, heart disease, osteoporosis, or mental health problems
  • Transitional care management services: Help from a health care provider for 30 days after returning home from a hospital or skilled nursing facility

Chemotherapy

If you have cancer, Medicare Part B covers chemotherapy you receive at a doctor’s office, at a freestanding clinic, or as a hospital outpatient. (Chemotherapy received as a hospital inpatient is covered by Part A.)

Chiropractic care

It’s limited, but Medicare does cover manipulation of the spine when it’s medically necessary. When the bones of your spine move out of position, it’s called subluxation, and Medicare covers chiropractic care in that case. Medicare doesn’t cover any other services or tests from a chiropractor, however.

Clinical trials

Clinical trials are research studies that test new medical treatments and approaches. If you want to join one, Medicare covers related office visits and tests.

Diabetes

  • Foot exams and treatment: Every six months if you have diabetes-related nerve damage
  • Diabetes equipment and supplies: Blood sugar (glucose) testing monitors, infusion pumps, test strips, lancets, glucose sensors, tubing, and insulin
  • Therapeutic shoes: Custom-molded shoes or extra-depth shoes (one pair per calendar year) and inserts (two to three per calendar year depending on type)

Diagnostic tests

  • Laboratory services: Blood tests, urinalysis
  • X-rays
  • MRIs
  • CT scans
  • Electrocardiograms (EKG/ECGs)

Equipment, supplies, and medical devices

  • Continuous positive airway pressure (CPAP) therapy: Rental of machine, purchase of masks and tubing
  • Durable medical equipment: Oxygen and oxygen equipment, wheelchairs, walkers, canes, and hospital beds for use at home
  • Eyeglasses: One pair with standard frames (or one set of contact lenses) after each cataract surgery
  • Implantable automatic defibrillator: When surgery is outpatient (Part A covers inpatient surgery)
    Outpatient medical and surgical supplies: Casts, stitches

Foot care

  • Exams and treatment related to nerve damage from diabetes
  • Treatment for injuries or diseases, such as hammer toe, bunion deformities, or heel spurs

Note that routine foot care is not covered by Medicare.

Prosthetic/orthotic items

  • Arm, leg, back, and neck braces
  • Artificial eyes
  • Artificial limbs (and their replacement parts)
  • Prosthetic devices to replace an internal organ or function of an organ: ostomy supplies, parenteral and enteral nutrition therapy, some breast prostheses after mastectomy

Hearing and balance exams

These exams are covered by Part B if your health care provider orders them to determine if you need treatment for a medical condition.

Kidney disease

  • Dialysis services: Three dialysis treatments each week if you have end-stage renal disease (ESRD), all laboratory tests, home dialysis training, and support services
  • Dialysis supplies: ESRD-related drugs, biological products, and equipment
  • Kidney disease education services: Up to six sessions of kidney disease education services if you have stage 4 chronic kidney disease

Medications

In general, most prescription drugs are covered by Medicare Part D, not Part B. These are the few exceptions that are covered by Part B:

  • Injections you get in a doctor’s office
  • Certain oral anti-cancer drugs
  • Drugs used with some durable medical equipment, such as a nebulizer or external infusion pump
  • Immunosuppressant drugs (to prevent the immune system from rejecting a new organ after transplant surgery)

Mental health care

  • Hospital care: Outpatient or partial hospitalization (inpatient care for mental health is covered under Part A)
  • Behavioral health integration services: Help from a health care provider to manage depression, anxiety, or another mental health condition

Opioid treatment

  • Medication
  • Counseling
  • Drug testing
  • Individual and group therapy

Second opinions

For non-emergency surgeries, Medicare Part B will pay for you to get a second surgical opinion, and sometimes a third.

Surgical dressing services

Part B covers treatment of a surgical wound, when medically necessary.

Therapy and rehabilitation

  • Cardiac rehabilitation: Exercise, education, and counseling related to a heart condition or heart procedure
  • Occupational therapy: Evaluation and treatment to help you perform daily activities (dressing, bathing)
  • Physical therapy: Evaluation, exercises, and equipment to help you regain, improve, or slow the decline of your body’s physical functioning
  • Pulmonary rehabilitation: If you have moderate to very severe chronic obstructive pulmonary disease (COPD)
  • Speech-language pathology: Evaluation and treatment to regain, strengthen, or maintain your speech and language skills (includes cognitive skills and swallowing)

Transplants

Part B covers doctor services for transplants such as heart, lung, kidney, pancreas, intestine, liver, bone marrow, and cornea.

Travel

Medical care abroad isn’t covered by Part B in most cases, but there are a few exceptions:

  • While on board a ship within the territorial waters of the US
  • If you are in either the US or Canada, and a foreign hospital is closer than the nearest US hospital that can treat you

So what’s not covered by Medicare Part B?

The list above seems long, but there are some medical categories not covered by Part B:

  • Acupuncture
  • Concierge care: When a doctor’s office charges you a membership fee for services or amenities not covered by Medicare. Also sometimes called concierge medicine, retainer-based medicine, boutique medicine, platinum practice, or direct care
  • Cosmetic surgery: Unless medically needed because of injury or to improve function
  • Dental care: Cleanings, fillings, tooth extractions, dentures, and dental plates (certain emergency or complicated dental procedures in the hospital may be covered by Part A)
  • Eye exams for glasses or contact lenses
  • Gym memberships and fitness programs
  • Hearing aids and associated exams
  • Long-term care/custodial care: Help with basic personal tasks, such as bathing, dressing, eating, and using the toilet (most nursing home care falls into this category)
  • Massage therapy
  • Routine foot care: Care related to nerve damage from diabetes or treatment of an injury or disease is covered
  • Routine physical exams: Instead, Medicare covers only a “Welcome to Medicare” visit during your first 12 months on Part B and an annual “Wellness” visit

Many Medicare Advantage plans (Part C) include coverage for some of the items above, including vision, hearing, dental, and gym memberships. If these services are important to you, learn more about Medicare Advantage.

Also, note that Part B doesn’t pay 100% of expenses, even for covered services. You may be responsible for copays, coinsurance, and deductibles. To cover those additional costs, one solution to explore is a Medicare Supplement Plan, also known as Medigap.

Find out if something is covered by Medicare Part B

If you have questions about a particular item not listed above, ask your doctor or health care provider if Medicare covers it. You can also consult Medicare.gov’s coverage search tool or call Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users can reach Medicare at 1-877-486-2048.

If you have a smartphone, Medicare also now offers a free mobile app, called “What’s Covered.” You can find it on the Apple App Store or Google Play store by searching for “what’s covered” or “Medicare.” The app’s logo is a white “M” on a blue background, with a green check mark in the middle.

The takeaway

It feels good to visit a health care provider when you know exactly what to expect. By understanding what Part B covers, you can avoid surprise bills and make better decisions about your care.

There’s more to Medicare than Part B. Take a look at our Medicare Guide to see which other parts of Medicare might cover additional services.

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Sources:

Medicare.gov, “Medicare & You 2020

Medicare.gov, “Your Medicare Coverage

Medicare.gov, “Your Guide to Medicare Preventive Services

Content on this site has not been reviewed or endorsed by the Centers for Medicare & Medicaid Services, the United States Government, any state Medicare agency, or any private insurance agency (collectively "Medicare System Providers"). Eligibility.com is a DBA of Clear Link Technologies, LLC and is not affiliated with any Medicare System Providers.

Written by
Kathryn Anne Stewart
Kathryn Anne Stewart is a freelance writer who covers the intersection of health and money. She has written for Johns Hopkins Medicine, Weight Watchers, Newsmax Magazine, Franklin Prosperity Report, and the National Hemophilia Foundation, often crafting clear explanations of complex topics. When she's away from her desk, you can find her reading a library book, watching stand-up comedy, or cycling with her husband.
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