Medicare Part B: Your Complete Guide to Medicare Part B
Medicare Part B is medical insurance funded by the government. Part B helps cover the cost of medical expenses that are not covered by Part A hospital insurance such as doctor’s visits, outpatient care, and some preventive services. You must be enrolled in Medicare Part A to enroll in Part B. Enrolling in Part B can reduce the cost you pay for regular medical services and services you receive during hospital stays.
Part B Eligibility
You are eligible for Medicare Part B if:
You are over 65 and receive Social Security or Retired Railroad Board benefits.
You are under 65 and disabled.
You have Amyotrophic Lateral Sclerosis.
Video: Medicare Facts
Medicare Part B Cost
There is a basic $96.40 monthly premium for Part B coverage. The premium amount could be higher if you and your spouse have an income higher than $170,000 (only if your tax return is married filing jointly). Similarly, a single tax filer will have a higher Part B premium if his income is higher than $85,000.
If you don’t sign up for Part B when you are first eligible, your premium could increase by 10% for an entire year. There are some exceptions that allow you to avoid the late enrollment penalty. For example, if you waited to sign up for Part B coverage because you had an employer’s group health plan.
Get Help Paying Part B Costs
You may be able to receive assistance from your State Medical Assistance office if you have low income and need help paying your Premium for Part B. To qualify for assistance you should meet these conditions:
You must have Part A.
If you are a single person, you must have monthly income less than $1,190 and resources less than $4,000.
If you are married, you must be living with your spouse and have monthly income less than $1,595 and resources less than $6,000.
Resources include money in a checking or savings account, not your car, burial plot, furniture or other items in your home.
Call Medicare at 1-800-633-4227 to find out more about getting assistance with your Medicare costs.
What is Covered by Medicare Part B?
These are some of the services that are covered by Medicare Part B.
Abdominal Aortic Aneurysm Screening
To have this screening covered, you must receive a referral during your initial physical exam.
Part B covers one screening only.
Ambulance Services
Part B covers emergency ground transportation when being transported in another vehicle would put your health at risk.
You may receive coverage for airplane or helicopter emergency transportation when you require more immediate transportation.
Non-emergency transportation may be covered under doctor’s orders.
Ambulatory Surgical Centers
Part B pays the facility fees when you have an approved surgical procedure conducted. You will be responsible for paying any charges not covered by Medicare.
Bone Mass Measurement
Part B covers this preventive service every 24 months unless it is medically-necessary for you to receive it more often.
You must meet certain criteria to have the services covered.
Cardiovascular Screenings
Every 5 years you may have your cholesterol, lipid, and triglyceride levels.
Chiropractic Services
You can receive services to fix a subluxation which occurs when the bones in your spine have moved out of position.
Clinical Laboratory
Part B covers services that are performed in a clinical laboratory.
This includes things like blood tests, urinalysis, and screening tests.
Clinical Research Studies
If you participate in a qualifying research study, Medicare covers some of the costs, e.g. doctor visits and tests.
Colorectal Cancer Screenings
If your doctor orders is you may receive certain tests to help find precancerous growths.
Fecal Occult Blood tests may be conducted annually for those over 50.
Flexible Sigmoidoscopy can be conducted every 48 months for those over 50, or 120 months for those not at high risk.
Colonoscopy can be conducted every 120 months or 24 months for those at high risk.
Barium Enema can be conducted once every 48 months for those over 50 or 24 months for those at high risk.
Defibrillator
If you have been diagnosed with heart failure, Part B covers this service.
Diabetes Screenings
Covered if you have risk factors for diabetes including high blood pressure, abnormal cholesterol and triglyceride levels, obesity, or high blood sugar.
Part B also covers up to two screenings annually if you are over 65, overweight, have a family history of diabetes, have a history of gestational diabetes, or delivered a baby weighing more over 9 pounds.
Diabetes Self-Management Training
If your doctor orders it, Part B covers this service.
Diabetes Supplies
Covered supplies include blood sugar testing monitors and test strips, lancets and lance devices, blood sugar control solutions, some therapeutic shoes, and insulin when used with an insulin pump.
Doctor Services
Medically-necessary services and certain preventive services are covered. Routine physicals outside the initial Medicare physical are not covered.
Durable Medical Equipment
Certain equipment is covered as ordered by your doctor. This includes things like wheelchairs, walkers, hospital beds, and oxygen equipment. You may have to rent the items first.
Emergency Room Services
You are responsible for paying a co-payment for the emergency room visit.
Eye Exams
People with diabetes can receive an annual eye exam to check for diabetic retinopathy.
Eyeglasses
If you have a cataract surgery that implants an intraocular lens, you can receive one pair of eyeglasses with standard frames.
Federally Qualified Health Center Services
A range of outpatient preventive services and primary care is covered.
Flu Shots
The shot is covered once each flu season during the fall and the winter.
Foot Exams and Treatment
Those with diabetes nerve damage and certain other conditions are covered for this service.
Glaucoma Tests
You can receive glaucoma testing once a year if you have diabetes, a history of glaucoma, are an African-American over 50, or are a Hispanic over 65.
Hearing and Balance Exams
These exams are covered if ordered by your order to determine medical treatment.
Hearing aids and exams are not covered.
Hepatitis B Shots
This shot is covered if you have hemophilia, End-Stage Renal Disease, or a condition that lowers your resistance to infection.
Your doctor can determine if you have other factors that increase your risk for Hepatitis B.
Home Health Services
Certain medically-needed services are covered including part-time nursing care, part-time physical therapy, speech-language pathology, or occupational therapy.
Your doctor must order the services.
The services must be provided by a home health agency that has been Medicare-certified.
Kidney Dialysis Services and Supplies
This service is covered for people with End-Stage Renal Disease when ordered by a doctor.
Mammograms
Women over 40 can receive a mammogram once every 12 years.
Women between 35 and 39 can receive a single mammogram.
Medical Nutrition Therapy Services
If you have diabetes or kidney disease, your doctor may refer you to receive medical nutrition therapy.
Mental Health Care
Covered services include doctor, psychiatrist, clinical psychologist, and clinical social worker visits. Certain limits and conditions apply.
Occupational Therapy
Your doctor must certify that you need certain evaluation and treatment to return to normal activities.
Outpatient Hospital Services
Part B covers services you receive on an outpatient basis that are part of a doctor’s care.
Outpatient Medical and Surgical Services and Supplies
Certain approved procedures are covered including X-rays, casts, or stitches.
Pap Tests and Pelvic Exams
Screenings are covered once every 24 months. Women at high risk including those in child-bearing age who have had abnormal exams may receive exams every 12 months.
Physical Exam
Medicare covers a one-time physical exam to review your health. To have Medicare cover its share of the exam cost, you must receive this exam within the first 12 months of receiving Part B.
Physical Therapy
If ordered by your doctor, Part B covers evaluation and treatment for injuries that change your ability to function.
Pneumococcal Shot
This shot is typically given once during a lifetime and helps prevent certain types of pneumonia and other infections.
Practitioner Services
Part B covers those services provided by nurse practitioners and physician assistants.
Prescription Drugs
Certain drugs that are received in hospital outpatient care, those injected in a doctor’s office, some oral cancer drugs, and some types of durable medical equipment are covered.
Prostate Cancer Screenings
Men over 50 can receive a screening once every year.
Prosthetic/Orthotic Items
Certain items, like arms, legs, back and neck braces, are covered when a doctor orders them.
Video: Medicare Supplement vs. Medicare Advantage
Rural Health Clinic Services
Part B covers a range of outpatient primary care services received at one of these clinics.
Second Surgical Options
When surgery is an emergency, Part B covers some second and third options.
Smoking Cessation
If you are diagnosed with an illness that was caused or is complicated by the use of tobacco, you may receive 8 face-to-face visits during a year.
Speech-Language Pathology Services
When your doctor orders it, you may receive treatment to help regain and strengthen speech and language skills.
Surgical Dressing Services
Part B covers services that are needed to treat a surgical or surgically-treated wound.
Telemedicine
Under certain conditions, Part B covers health services given over the phone, by computer, or through the television.
Tests
Certain tests like X-rays, MRIs, CT scans, and EKGs are covered.
Transplants and Immunosuppressive Drugs
Under certain conditions, doctor services are covered if they are given in a Medicare-certified facility.
Heart, lung, kidney, pancreas, intestine, liver, bone marrow, and cornea transplants may be covered.
Immunosuppressive drugs are covered if the transplant was paid for my Medicare.
Travel Health Care
On an exception basis, you may receive health care when you travel outside the U.S. if you are on board a ship within the U.S. territorial waters.
Urgently-Needed Care
Part B covers sudden illnesses or injuries that are not medical emergencies.
If you have a question about a service that is not included on this list, you can search the Medicare website at www.medicare.gov. Select the option that reads “Find Out What Medicare Covers.” You can also contact Medicare by phone at 1-800-MEDICARE or 1-800-633-4227.