Medicare Part B is an optional plan that covers medical outpatient services and most doctor visits. It also covers things such as mental health services, ambulance services, clinical research, etc. Signing up for Part B is a choice, but you can’t have Part B unless you also get Part A.
What Does Medicare Part B Cover?
Part B covers an extensive number of different things, which are split into two categories: preventative services and medically necessary outpatient care. Most care you’ll receive under Part B requires a 20 percent coinsurance or copay fee. Fortunately, the majority of preventative services are provided for free. Essentially, Medicare Part B covers preventative services that could save Medicare money in the long run.
Examples of the things that Medicare Part B will cover in full include:
- Flu shots
- Mammograms
- COVID-19 vaccines
- Screening colonoscopies
Examples of the things that Medicare Part B will cover 80 percent of include:
- Ambulance services
- Outpatient services
- Prescription drugs
- Durable medical equipment
- Mental health services
Before you begin to receive care, you’ll need to find a medical provider who accepts Medicare. Other services are provided as long as they’re deemed medically necessary. However, you’ll need to pay a deductible before Medicare steps in to cover 80 percent of the fee. Once you’ve reached your deductible, you’ll still have to pay 20 percent of whatever services or procedures you need.
Medically Necessary Outpatient Care
As you’ll see below, there are specific criteria that must be met for a service to be considered medically necessary. Make sure if you use one of these services, that you verify you’re eligible to use Medicare.
Ambulance Services – An ambulance ride to the nearest hospital will be covered if, and only if, traveling in an alternate vehicle would put your health at risk. In other words, if you call an ambulance because you broke your arm, it’s not likely to be covered. Calling an ambulance after a heart attack would qualify, though.
Outpatient Services – Outpatient services cover a large list of different medical needs. The most important part is that you can be treated at a clinic, office or health care provider without needing to be hospitalized. Stitches, casts and X-rays fall under this category.
Prescription Drugs – Applies to all prescription medications, except for injections or infusions that you need to receive at a hospital outpatient department or your doctor’s office. Of course, most prescription drugs are also covered by Medicare Advantage or Medicare Part D.
Durable Medical Equipment – If you have a prescription from your doctor for a medically necessary piece of medical equipment, it will usually be covered. Examples include hospital beds, diabetes supplies, wheelchairs, walkers, canes, CPAP machines and lift chair mechanisms.
Mental Health Services – This covers counseling or therapy sessions, medication management, psychiatric evaluations and partial hospitalizations for your mental health issues. If you need to be admitted as an inpatient, Medicare Part A will take care of it.
What Doesn’t Part B Cover?
Again, Medicare Part B is designed to help patients with things that are medically necessary. For instance, if you need breast reconstructive surgery after a mastectomy, it would be covered. If you simply want breast augmentation surgery, though, it will not be covered. Other things that aren’t covered include:
- Long-term care
- Routine foot care
- Cosmetic surgery
- Dentures
- Hearing exam
- Hearing aids
- Vision exam
However, Medicare Advantage plans do cover some of these important things. You may be able to get your routine hearing, vision and dental care taken care of by purchasing a Medicare Advantage plan. Be aware that not all plans cover these things, so make sure you confirm exactly what you’ll be eligible to receive.
Cost of Having Part B
The cost of purchasing a Medicare Part B plan will be $174.70 in 2024. It’s important to add that some people may be charged more, based on their exact income, but the majority of Medicare Part B users will pay the same amount. When you go through the Medicare approval process, you will be told what your exact price will be for Part B.
Medicare Part B can be an extremely helpful add-on to your existing Medicare Part A plan. Unlike Part A, Part B pays for the things you’ll be more likely to need on a regular basis. Part A may cover inpatient hospital care, surgeries, hospice care and lab tests, but what most people truly need is coverage for preventative services and outpatient care.