Medicare Part B
Medicare Part B covers two types of services:
- Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.
- Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage when treatment is most likely to work best.
Part B covers things like:
- Clinical research
- Ambulance services
- Durable medical equipment
- Mental health
- Limited outpatient prescription drugs
Medicare Part B (Medical Insurance) covers:
- Abdominal aortic aneurysm screening
- Alcohol misuse screenings & counseling
- Bone mass measurements (bone density)
- Cardiovascular disease screenings
- Cardiovascular disease (behavioral therapy)
- Cervical & vaginal cancer screening
- Colorectal cancer screenings
- Multi-target stool DNA tests
- Screening barium enemas
- Screening colonoscopies
- Screening fecal occult blood tests
- Screening flexible sigmoidoscopies
- Depression screenings
- Diabetes screenings
- Diabetes self-management training
- Glaucoma tests
- Hepatitis B Virus (HBV) infection screening
- Hepatitis C screening test
- HIV screening
- Lung cancer screening
- Mammograms (screening)
- Nutrition therapy services
- Obesity screenings & counseling
- One-time “Welcome to Medicare” preventive visit
- Prostate cancer screenings
- Sexually transmitted infections screening & counseling
- Shots:
- Flu shots
- Hepatitis B shots
- Pneumococcal shots
- Tobacco use cessation counseling
- Yearly "Wellness" visit
What is not covered by Medicare Part A & Part B?
Medicare does not cover everything. Some of the items and services Medicare does not cover include:
- Long-term care (also called custodial care)
- Most dental care
- Eye exams related to prescribing glasses
- Dentures
- Cosmetic surgery
- Acupuncture
- Hearing aids and exams for fitting them
- Routine foot care
Find out if Medicare covers a test, item, or service you need here:
https://www.medicare.gov/coverage/is-your-test-item-or-service-covered
What do I pay for Part B-covered services?
You will pay more if you see doctors or providers who do not accept assignment. If you are in a Medicare Advantage Plan or have other insurance (like a Medigap policy, Medicaid, or employer or union coverage), your copayments, coinsurance, or deductibles may be different.
Under Original Medicare, if the Part B deductible ($198 in 2020) applies, you must pay all costs (up to the Medicare-approved amount) until you meet the yearly Part B deductible. Visit Medicare.gov in the Fall of each year to find out how much the Part B deductible will be.
After your deductible is met, Medicare begins to pay its share and you typically pay 20% of the Medicare-approved amount of the service if the doctor or other health care provider accepts assignment. There is no yearly limit for what you pay out-of-pocket.
You pay nothing for most covered preventive services if you get the services from a doctor or other qualified health care provider who accepts assignment. However, for some preventive services, you may have to pay a deductible, coinsurance, or both. These costs may also apply if you get a preventive service in the same visit as a non-preventive service.