By: Eligibility Team

Medicare is complex and can be hard to understand at times. But Medicare Part B, which is one of the two components of Original Medicare along with Part A, is fairly straightforward. In general, Part B helps you pay for health care services outside of inpatient care that keep you well or treat you if you’re ill or injured.

So what types of services does that include? The graphic below offers a quick look at some of the main parts of Part B coverage.

However, that’s not the full picture. Below we break down Part B and discuss what it covers, what it doesn’t cover, what the coverage costs, and how to get it.

Part B coverage for medically necessary services

Medicare Part B plans help you pay for services like doctor visits, lab tests, and outpatient surgeries that are “medically necessary.” Medicare defines medically necessary care and items as “services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.” In other words, Part B covers outpatient care for illness or injury.

That’s not very specific, but fortunately, we can break down Part B services even further into several categories. The main thing to remember is that Medicare will cover these services only if it considers them medically necessary.

Medicare Part B coverage for medically necessary services includes the following:

  • Doctor visits: Part B covers you when you visit doctors, including primary care physicians like general practice doctors or specialists such as podiatrists.
  • Lab tests: If your doctor orders certain laboratory tests, like cholesterol blood tests, Part B covers them.
  • X-rays: At the doctor for that potentially broken wrist? Part B will cover an x-ray to check.
  • Outpatient surgeries: As opposed to inpatient surgeries, which are done after being admitted overnight to a hospital, outpatient surgeries typically happen within the same day.
  • Clinical research: Certain types of clinical research, such as studies done to assess the effects of prescription drugs, are covered by Part B.
  • Ambulance services: If your life or health are in serious danger, Part B will cover ambulance transportation to a hospital or other necessary medical facility.
  • Durable medical equipment (DME): DME includes all sorts of items like canes and walkers, wheelchairs and lift chairs, and oxygen equipment.
  • Mental health: Part B covers many types of mental health care, including visits with psychiatrists or social workers, as well as mental health services provided in an outpatient setting. This category also covers treatment for alcohol and drug misuse.
  • Second opinions: Need a second opinion before having surgery? Part B will pay for you to talk to another physician so you can make the best decision.
  • Some outpatient prescriptions: Most prescription drugs aren’t covered by Part A or B—you’ll need a Part D plan for that. But Part B does cover some drugs given to you by a doctor or as part of outpatient hospital care.

The descriptions above are general guidelines for Part B coverage. For more information, head over to Medicare’s Part B coverage guide, or use Medicare’s search tool to find out if a service or item you need is covered.

Part B coverage for preventive care

Part B covers another type of treatment: preventative care. Medicare defines this care as “health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best.”

Basically, if Medicare thinks a service will keep you well, Part B will cover it. This includes a whole host of doctor visits, screenings, tests, and other services, and you’ll find many of these divided into categories below.

Preventive care: Screenings, tests, and measurements

Your doctor may recommend that you get a certain screening, test, or measurement because of your family history, your genetic makeup, or another factor. These services help determine if you have an illness or disease—or are at risk of developing one.

  • Abdominal aortic aneurysm screenings
  • Alcohol misuse screenings
  • Bone mass (bone density) measurements
  • Cardiovascular disease screenings
  • Cervical and vaginal cancer screenings
  • Colorectal cancer screenings
  • Depression screenings
  • Diabetes screenings
  • Glaucoma tests
  • Human immunodeficiency virus (HIV) screenings
  • Lung cancer screenings
  • Mammograms
  • Hepatitis C screenings
  • Obesity screenings
  • Prostate cancer screenings
  • Sexually transmitted infections (STI) screenings

Preventive care: Counseling, therapy, and training

To manage certain illnesses, diseases, or conditions, Part B will cover counseling, therapy, or training services.

  • Alcohol misuse counseling
  • Diabetes self-management training
  • Heart disease behavioral therapy
  • Nutrition therapy
  • Obesity counseling
  • STI counseling
  • Tobacco use cessation counseling

Preventive care: Doctor visits

Part B covers two types of preventive doctor visits at no extra cost to you.

  • Welcome to Medicare visit: You’re covered for this one-time visit within your first 12 months of having Part B. During this visit, which includes a full physical exam, you can expect your doctor to provide services like blood pressure measurements, body mass index measurements, and vision tests.
  • Annual “Wellness” visit: Each year, Part B covers a “Wellness” visit that helps you and your doctor stay on top of any conditions you have and develop plans to prevent future illnesses.

Preventive care: Vaccinations (shots)

One of the best ways to keep yourself and others from getting sick is to get vaccinated. If you have Part B, you pay nothing for the shots below:

  • Flu shots
  • Hepatitis B shots
  • Pneumococcal shots

To learn more about preventive services, including how often Part B covers something, Medicare has a detailed list of covered preventive services and screenings.

More examples of Part B coverage

Understandably, you may have questions about a specific health care service and whether Part B covers it. Lucky for you, we have a Frequently Asked Medicare Questions page. Here are some common FAQ pages that may help you get the information you’re looking for.

How does Medicare decide what to cover?

As a United States government program, Medicare coverage is subject to federal and state laws that guide the organization on what to cover. Some decisions are made at the national level, while others are made at the state level by companies that process Medicare claims. These companies refer to government laws to determine if something is medically necessary or considered preventive and should be covered.

What Part B doesn’t cover

Although Part B covers a lot of services, it doesn’t pay for everything. For some services and items, you’ll need other types of coverage. Here are some key services Part B doesn’t cover.

  • Inpatient hospital, home health, hospice, and skilled nursing services: These services are covered by Part A. However, there are some exceptions. For example, Part B pays for some home health services, so you’ll need to check with Medicare to be sure.
  • Prescription drugs: Except for certain drugs, Part B doesn’t cover prescriptions. But Part D does, and you can learn all about Part D coverage here.
  • Foreign travel emergency services: If you’re traveling outside the United States and get sick or injured, Part B won’t cover it. If this concerns you, consider purchasing a Medicare Supplement (Medigap) plan that includes foreign travel emergency coverage.
  • Routine dental, vision, and hearing services: Medicare generally doesn’t cover services and items like dental cleanings, dentures, eye exams, and hearing aids. Many Medicare Advantage (Part C) plans do include dental, vision, and hearing services, which is a key reason many people choose to buy Advantage plans.

How much Part B coverage will cost you

To get Part B coverage, you’ll have to pay a monthly premium. In 2020, the standard monthly premium is $144.60 (up from $135.50 in 2019). If you make more than $87,000 ($174,000 for married couples), however, you may pay more.1

Learn more about Part B premiums and deductibles.

Fortunately, when it comes to knowing how much you’ll pay for a covered Part B service, it’s pretty simple. Usually, you pay the amount directly to the Part B providers giving you care, and what you pay generally comes down to two options:

  • Medically necessary services: After your Part B deductible ($198 in 2020),2 you pay 20% of the Medicare-approved cost. For example, if a wheelchair rental costs $50 per month, you’ll pay $10.
  • Preventive services: You pay nothing.

Still, there are some exceptions to those rules. Some services—like physical, occupational, and speech therapy—have limits on the amount Medicare will pay. Head over to Medicare.gov to find out the coverage for specific Part B services.

Have more questions or want to enroll in Part B?

If you don’t already have Part B, there are certain rules that apply for getting it. Here are some basic things to remember about Part B enrollment:

  • You don’t have to enroll in Part B. It’s optional.
  • But if you don’t enroll in Part B when you’re first eligible, you may pay a late enrollment penalty to sign up later.
  • Most people are first eligible for Part B during their seven-month Initial Enrollment Period.
  • If you have both Part A and Part B, you can purchase a Medicare Advantage plan that combines both parts and usually includes extra coverage.
  • To sign up for Part B, you can apply online, visit your local Social Security office, or call 1-800-772-1213 (TTY 1-800-325-0778). Visit our FAQ page “How Do I Apply for Medicare?” to learn more.

If you need more information about Part B or other Medicare coverage types, check out these other pages:

Sources

  1. Medicare, “Part B Costs
  2. Medicare, “Part B Costs

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.