What Does Medicare Part B Cover?

What Does Medicare Part B Cover? When people become eligible for Medicare health insurance due to age or disability, they can get their benefits through Original Medicare or Medicare Advantage.

Original Medicare is divided into two parts – Part A which is hospital insurance, and Part B which is medical insurance. Original Medicare beneficiaries can also sign up for prescription drug coverage with a separate Part D plan. 

Medicare Advantage, also known as Medicare Part C, provides the same coverage as Parts A and B of Original Medicare, but they are bundled together into one plan. Most Part C plans also include prescription drug coverage and extra benefits.

A great number of people who are eligible for Medicare are eligible for premium-free Part A benefits. However, Part B carries a monthly premium ($148.50 for the standard Part B premium in 2021) and enrollment is optional.

What does Medicare Part B cover?

Medicare Part B covers two types of outpatient healthcare services, medically necessary care and preventive services. Let’s look at each type of these services in more detail.

Medically necessary care

Medicare covers services and/or supplies that are necessary for the diagnosis or treatment of a medical condition if they meet accepted medical practice standards. 

Some examples of medically necessary services covered by Part B are:

• Annual physical exams
• Diagnostic tests like X-rays, CT scans, echocardiograms blood and other lab tests
• Emergency transport by ambulance
• Chemotherapy
• Durable medical equipment such as wheelchairs, walkers, oxygen equipment, etc.
• Emergency room visits
• Kidney dialysis
• Physical, occupational, and speech therapy
• Outpatient hospital care
• Outpatient mental health care
• Doctors’ services related to transplants
• Certain prescription medications that aren’t self-administered
• Some home health services
• Medical nutrition therapy services
• Counseling to stop smoking
• Diabetes supplies
• Medical nutrition therapy

Preventive services

Medicare covers preventive health care services that are necessary or helpful in preventing illnesses, or in detecting illnesses at an early stage so treatment can be more successful. 

Some examples of Medicare-covered preventive services include:

• Screening for cancers like breast, bone, prostate, etc.
• Bone density measurement
• Screening for cardiovascular disease
• Testing for diabetes
• Testing for Hepatitis B and C, as well as HIV
• Screenings for sexually transmitted diseases and/or infections
• Vaccinations for flu, Hepatitis B, pneumococcal virus, COVID-19, etc.
• Mammograms
• Glaucoma and macular degeneration screening
• Screening for abdominal aortic aneurysm
• Foot examinations for diabetic patients

How much do Medicare beneficiaries pay for Part B services?

Medicare generally pays 80 percent of the final approved cost for Medically necessary services. However, you must get these services from a physician or other health care provider who accepts Medicare assignment to be eligible for the benefit. You are responsible for the remaining 20 percent of the cost of the service, and you must pay your Part B deductible. In 2021, this amount is $203.00. 

Medicare pays 100 percent of the cost of some preventive services if they are provided by a physician or health care provider who accepts Medicare assignment. Also, you do not have to pay the annual Part B deductible to be eligible for preventive care services.