You’ve got your Medicare in place. Congratulations! But now, you need to know what each part of your Medicare coverage includes, so you know how to make the most of your benefits and how to plan for any medical expenses not covered by Medicare.
In this article, we’re going to focus on Medicare Part B. We’ll discuss what it does and does not cover, as well as some other basic information about what it costs and what your portion of medical expenses could be.
Types of Services Covered by Medicare Part B
Essentially, Medicare Part B covers two types of services: medically necessary outpatient services and preventive services.
Medically necessary services are those that are required to diagnose and treat the medical condition you present with. These services or supplies must meet the accepted standards of medical practice.
Preventive services are those used to prevent illness either altogether or at least at a very early stage when treatment is most likely to succeed.
To determine if the treatment qualifies for coverage under Part B, it must meet three requirements. First, it must pass federal and state laws. Second, it must have been an approved service based on Medicare’s national coverage decisions. Third, the service must have been approved locally by companies in each state. These companies are the ultimate deciding factor on whether or not a service should be deemed medically necessary in that area.
What does Medicare Part B cover?
So, once the service passes all those requirements, what exactly does Medicare Part B cover? There are a few categories as well as specific services we’ll list here, but our list is not exhaustive.
Medicare Part B covers outpatient services such as doctor’s visits, outpatient care, diagnostic tests, and preventive care. Preventive care may include certain vaccines, screenings, mental health services, and wellness visits, and annual checkups. It also includes coverage for durable medical equipment.
Part B also includes coverage for some services you receive as part of an inpatient hospital stay. This will include surgeries, chemotherapy, diagnostic images, and dialysis. If you are given medications while an inpatient, it will also cover those.
Here is a list of services and equipment that are included in Medicare Part B coverage.
Services
- Doctor’s visits
- Diagnostic imaging
- Cancer screenings: prostate and colorectal
- Mammograms
- Depression screenings
- Diabetes screenings
- Durable Medical Equipment
- Shots: Pneumococcal, Hepatitis B, flu, COVID-19
- Alcohol abuse screenings/counseling
- Tobacco cessation
- Outpatient services
- Occupational and physical therapy
- Speech-language services
- Some chiropractic treatment
- Telehealth visits
- Ambulance transportation (under certain circumstances)
- Clinical research
- Outpatient prescriptions (those you would not administer yourself and/or those that are injectable, such as injections for osteoporosis)
Durable Medical Equipment
- Crutches
- Walkers
- Hospital beds
- Blood sugar monitors
What does Medicare Part B not cover?
There are a few things that Medicare Part B does not cover, which will greatly impact your decision to seek additional coverage outside of Original Medicare (Parts A and B).
Part B does not cover routine dental, vision, or hearing benefits, outpatient prescription drugs, or long-term care. It does not cover any service that has not been deemed medically necessary.
Some services not included in Part B include:
- Eye exams and prescription glasses or contact lenses
- Preventive dental services and restorative treatment
- Cosmetic services
- Long-term care
- Acupuncture (except when used to treat lower back pain)
- Podiatry care
- Hearing exams and hearing aids
The Cost of Medicare Part B
There are a few costs associated with Medicare Part B.
Part B Premium
Medicare Part B does have a monthly premium. In 2021, the standard premium was $148.50. However, those with higher incomes will pay a higher premium. Those with low incomes may qualify for a low-income subsidy that could decrease their monthly payment.
Part B Deductible
In 2021, the deductible for Part B was $203. Individuals must meet this deductible prior to having any of their services covered. Services that would not have been covered by Medicare Part B do not go towards the deductible.
Part B Penalty
Hopefully, this one doesn’t apply to you! However, if you delayed enrollment in Part B without other creditable health insurance, you may be paying a penalty on top of your monthly premium. This is a minimum of an additional 10% of your premium. An extra 10% is added for each of the 12-month periods you delayed enrollment without other coverage in place.
Part B Coinsurance and Copays
The coinsurance amount is the percentage of the cost for services that you will pay after having met your annual deductible. This usually amounts to about 20% of the total cost.
Copays are not a frequent expense with Part B. You may need to pay one if you seek emergency care at a hospital and do not end up getting admitted as an inpatient.
Part B Out-of-Pocket Maximum
There is no out-of-pocket maximum associated with Medicare Part B. With other types of insurance coverage, you may be accustomed to having an out-of-pocket max. After this amount was met, the insurance would begin paying 100% of services. That is not the case with Medicare Part B.
Talk to your doctor or other medical providers to find out if the services they recommend are covered by Medicare. Healthcare expenses can add up quickly, so it’s important that you know what your expenses may be before having treatment.
To decrease your out-of-pocket expenses even more, talk to one of our licensed Medicare agents to get information on Medicare supplements and Medicare Advantage plans. Both of these types of coverage will give you additional benefits outside of Original Medicare and will save you money on your healthcare needs.
