Medicare Part B
The Medicare program has several “parts,” and you may wish to understand them all when making your health-care coverage choices. Learning how Medicare works will help you choose the best plan for your needs. One part of the Medicare program is called Medicare Part B.
What is Part B?
Medicare Part A and Part B, together, are called Original Medicare. Through the Center for Medicare &Medicaid Services, the United States government set up Original Medicare to cover a wide range of medical expenses for individuals 65 and older and individuals with certain disabilities. Part A is hospital insurance.
Medicare Part B is medical insurance; coverage includes (but is not limited to):
- Medically necessary doctor services
- Ambulance transportation
- Outpatient hospital care, such as some physical or occupational therapy
- Mental health services
- Some home health care services
- Durable medical equipment
What does it cover?
A range of preventive treatments, tests, services, and supplies are covered by Part B.
Medicare Part B covers the following:
Preventive and diagnostic services
- Physical examinations, including a one-time ‘Welcome to Medicare’ preventive visit and annual ‘Wellness’ visits*
- Tests, labs and screenings
- Glaucoma screening once a year if you’re at high risk for glaucoma and the test is performed by an eye doctor who’s legally authorized to give this test in your state
- Bone mass measurement, every two years (or as medically necessary), if you’re at risk for osteoporosis
- Lab services such as blood tests or urinalysis
- Colorectal cancer screenings to find any pre-cancerous growths and detect cancer early. If your doctor feels they’re necessary and you meet eligibility requirements, tests may include one or more of the following: annual fecal occult blood test, flexible sigmoidoscopy, colonoscopy screening, multi-target stool DNA test, and/or screening barium enema
- Diabetic screenings, if you have risk factors, such as high blood pressure, dyslipidemia, obesity, or high blood sugar; you’re also covered if two or more of the following factors apply:
- You’re 65 or older.
- You’re overweight.
- You have a family history of diabetes.
- You have a medical history of gestational diabetes or have delivered a baby weighing more than nine pounds.
- Diabetic supplies, such as monitors, test strips, lancet devices, and therapeutic shoes
- Diabetic self-management training for beneficiaries at risk for complications
- Cardiovascular screenings to help prevent heart attack or stroke. A screening consists of testing your triglyceride, lipid, and cholesterol levels every five years.
*Doctor services don’t include routine physical exams except the one-time “Welcome to Medicare” exam. You can get this free exam from a Medicare-assigned doctor during the first 12 months you’re enrolled in Part B. After you’ve had Part B for longer than a year, you’re covered for one annual “Wellness” visit every 12 months.
Doctor, hospital, and home health care
- Home health services (usually short-term), including limited, reasonable, and medically necessary intermittent care and services such as skilled nursing care, physical or occupational therapy, home health aide services, speech language pathology, and medical social services
- Certain durable medical equipment used at home, such as wheelchairs, hospital beds, walkers, and oxygen equipment
- Certain medical supplies, such as (but not limited to) continuous positive airway pressure (CPAP) devices, oxygen, and oxygen equipment
- Chiropractic services only if the purpose is to correct one or more of the bones that has moved out of place in your spine (subluxation); all other chiropractic services aren’t covered
- Ambulance services, if it’s a medical emergency and any other form of transportation would endanger your health
- Blood (pints) that you receive during an outpatient visit or another Part B-covered service
- Clinical trials, if the trial meets eligibility criteria for Medicare coverage
- Ambulatory surgery center fees for approved surgical services
- Emergency room services for severe injuries and illnesses that quickly worsen (note: emergency care is only rarely covered outside of the United States)
- One pair of eyeglasses and standard frames or one pair of contacts lenses after cataract surgery that inserts an intraocular lens
- Flu shots are covered one time per year during flu season.
- Pneumococcal vaccines are covered for all beneficiaries with Part B.
- Hepatitis B shots are covered if you’re at medium or high risk for the disease.
Additional services covered include, but are not limited to:
- Diagnostic hearing and balance exams (routine hearing exams or tests to get fitted for hearing aids aren’t covered)
- Pap tests, pelvic exams, and clinical breast exams to screen for breast cancer
- Outpatient mental health care services (for example, depression screenings)
- Medical nutrition therapy
- Hospital services that you get as an outpatient
- Occupational therapy
- Outpatient surgery service and supplies
- Limited prescription drugs you get in an outpatient setting (for example, chemotherapy drugs)
- Nurse practitioner services
- Physical therapy
- Prosthetic devices
- Transplant services
Part B premiums
You’ll typically pay a premium for Medicare Part B unless you qualify for financial assistance. Because of this, you have the option of turning it down, although you might pay a late-enrollment penalty if you decide to enroll in Medicare Part B later on. This monthly Part B premium amount may vary from year to year. Remember, you must have both Part A and Part B if you decide to enroll in a Medicare Advantage plan.
You can also check to see if you’re qualified to receive help from your state to help you pay for premiums or deductibles. Otherwise, the premium is usually deducted from a Social Security, Railroad Retirement, or Civil Service Retirement check. You can also choose to pay the Part B premium quarterly, through the electronic payment option, or through Medicare Easy Pay.
Overall, Part B provides many outpatient medical services to help minimize your health-care coverage worries. Still, it doesn’t cover everything; for example, routine dental care isn’t covered if you’re enrolled in Original Medicare, but some Medicare Advantage plans may offer this coverage. Whatever health-care coverage you choose, make sure you have a clear understanding of coverage options and costs.
Need help figuring out Medicare plan options that may work for your situation? Feel free to contact eHealth to speak with a licensed insurance agent and get assistance with your questions.