Medicare Part B is the part of Original Medicare that generally helps pay for outpatient medical care. While Medicare Part A is mainly connected to hospital care, Part B may cover many of the services you receive outside the hospital.
If you are turning 65, understanding Part B can help you prepare for doctor visits, tests, preventive care, and other everyday health needs. It can also help you see where you may still have costs to pay.
What is Medicare Part B?
Medicare Part B is medical insurance offered through Original Medicare. Most people pay a monthly Part B premium, along with a yearly deductible. After you meet the deductible, Part B often pays its share of Medicare-approved services, and you may pay the remaining portion.
For many covered services, Original Medicare generally pays 80% of the Medicare-approved amount after the Part B deductible. You may be responsible for the other 20%, unless you have other coverage, such as a Medicare Supplement plan, Medicaid, retiree coverage, or another type of insurance.
Part B coverage is not limited to one doctor or one hospital network. You can generally see any doctor or provider in the United States who accepts Medicare and is taking new patients. That flexibility is one reason some people consider Original Medicare with a Medicare Supplement plan.
What does Medicare Part B usually cover?
Part B may cover medically necessary services and supplies used to diagnose or treat a health condition. “Medically necessary” generally means a service or item that Medicare considers appropriate for diagnosing or treating your medical needs.
Common Part B-covered services may include:
- Visits with primary care doctors and specialists
- Outpatient surgery and hospital outpatient services
- Lab work, blood tests, and certain diagnostic tests
- X-rays, MRIs, CT scans, and other imaging services when medically necessary
- Emergency room services when you are treated as an outpatient
- Ambulance transportation in certain medically necessary situations
- Physical therapy, occupational therapy, and speech-language therapy when coverage rules are met
- Outpatient mental health care, including therapy and certain psychiatric services
- Durable medical equipment, such as walkers, wheelchairs, hospital beds, and oxygen equipment
- Diabetes screenings, supplies, education, and certain related services
Coverage can depend on the service, your medical situation, and whether your provider follows Medicare rules. Some services may need to meet specific requirements before Medicare will pay.
Does Medicare Part B cover preventive care?
Yes, Part B may cover many preventive services. Preventive care is intended to help find health concerns early or help you stay healthy. In many cases, Medicare covers eligible preventive services with little or no out-of-pocket cost when you use a provider who accepts Medicare assignment and all coverage requirements are met.
Examples may include:
- A welcome visit for people new to Medicare
- Yearly wellness visits
- Screenings for cancer, diabetes, heart disease, depression, and osteoporosis
- Flu shots and certain other vaccines
- Smoking and tobacco-use counseling
- Nutrition therapy for qualifying health conditions
It is important to know that a preventive visit can sometimes become a diagnostic visit. For example, if your doctor finds a concern and orders additional testing or treatment, you may have Part B cost-sharing for those additional services.
What does Medicare Part B not cover?
Part B does not cover every medical expense. Some services may not be covered at all, or they may only be covered in limited situations.
Examples of services that Original Medicare often does not cover include routine dental care, most routine vision care, hearing aids, routine foot care, cosmetic surgery, and care received outside the United States. Prescription drugs you take at home are also generally covered under Medicare Part D, not Part B.
There can be exceptions. For example, Part B may cover certain dental or vision services when they are medically necessary as part of another covered treatment. It may also cover some medications that are given in a doctor’s office or outpatient setting.
What will you pay for Part B services?
Your costs can vary based on the type of service, where you receive it, whether your provider accepts Medicare assignment, and whether you have other insurance.
With Original Medicare alone, you may have a monthly Part B premium, a yearly deductible, and coinsurance. Coinsurance is your share of the cost after Medicare pays its portion. For many Part B services, that share is often 20% of the Medicare-approved amount.
A provider who accepts Medicare assignment agrees to accept the Medicare-approved amount as full payment for covered services. This can make your costs easier to understand. Some providers do not accept assignment, which may mean you could pay more in certain cases.
Medicare Supplement insurance, also called Medigap, may help pay some or all of certain out-of-pocket costs left by Original Medicare. Benefits, premiums, availability, and rules can vary by plan, insurance carrier, and state.
How is Part B different from Medicare Advantage?
Medicare Advantage plans are another way to receive Medicare-covered Part A and Part B benefits through a private insurance company. These plans must cover all services that Original Medicare covers, except hospice care, which remains covered by Original Medicare.
Medicare Advantage plans may also include extra benefits, such as dental, vision, hearing, or prescription drug coverage. However, they often use provider networks and may have plan rules such as referrals or prior authorization for certain services.
With Original Medicare and Part B, you may have broader provider access nationwide when a provider accepts Medicare. A Medicare Supplement plan may help with some of the costs Original Medicare leaves behind. The best choice can depend on your doctors, travel habits, budget, prescription needs, and comfort with provider networks.
Why should you understand Part B before enrolling?
Part B is a major part of your Medicare coverage because it applies to many services people use regularly, including doctor appointments, outpatient testing, and preventive care. It can be helpful to review your expected health needs before choosing how you want to receive Medicare.
Consider the doctors you see, medications you take, whether you travel often, and how much cost-sharing you are comfortable paying. If you would like free, no-pressure help comparing Original Medicare, Medicare Supplement options, and other Medicare choices, reach out to Eric for guidance based on your situation.