What Does Medicare Part B Cover?

Original Medicare Part B Costs and Coverage Explained

by Ray Wilson+ on Feb 11, 2018 | 10 Comments

What is Medicare Part B and what does it cover? This is a question that most people turning 65 ask but struggle to find a clear answer. For starters, Original Medicare is made up of two parts: Medicare Part A (which mainly covers hospitalization) and Medicare Part B ( which covers your day-to-day medical coverage). This article will explain Part B but you can read more about Medicare A here.

What is Medicare Part B and What Does it Cover?

Medicare Part B is designed to help pay for most of your non-hospital related medical coverage. While technically optional, Part B is the coverage you’ll need if you don’t want to pay 100% of your doctor visits. Beyond doctor visits, Part B partially covers physical, speech, and occupational therapy,  second opinions, certain drugs administered by a doctor, and some durable medical equipment (wheelchairs, canes, scooters, etc). Along with Medicare Part B’s monthly premium, it still has out of pocket costs.

What will you pay under Medicare Part B?

Your Medicare Part B Costs:

  • Part B Premium for most people*: You pay $134 a month
  • Yearly Deductible: You pay $183
  • Most doctor services (including in-patient hospital doctor services): You pay 20% of the cost of the visit
  • Clinical Lab Services: You pay $0
  • Durable Medical Equipment: You pay 20%
  • Preventive Care: You pay $0
  • Part B Copayment: Depends on service
  • Home Health Services**: $0

 

*Those with higher incomes pay an increased premium.

**Although Home Health Services are completely covered at no cost to you, if you need durable medical equipment you will pay 20% of the cost.

What Does Part B Not Cover?

Here are a few examples of areas that Medicare Part B does not cover: hospitalization, hearing aids, dental, vision, acupuncture, excess charges at the doctors office, non-donated blood, and prescription drugs.

Notes about Part B Partial Coverage
As you can see Part B pays 80% of many medical related services which means that, without additional Medicare insurance, you will have to pay 20% of these costs. Additionally, Original Medicare Part B puts a limit on physical, speech, and occupational therapy.

Learn about Medicare Part A

Return to the Senior Medicare FAQ page

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Reader Comments and Questions

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By Joseph W on January 15, 2018

I collect SS now have part A & B also still working with my company insurance benefits. I plan to retire very soon what part Medicare do I need to cover my monthly medications which are extensive! Thank you.

You will need to purchase a Medicare Part D drug plan. We can help you enroll in that. Don't miss your deadlines!
-Michelle from Senior65.com


By Ronnie on October 11, 2017

So I would like to know how you are suppose to pay all your bills when they take out of your social security $ 134.00 every month for part B. Am I suppose to go bankrupt because I won't have enough to pay my bills with or should I cancel my life insurance to make ends meet. Since I don't make enough on social security will the state cremate me for free since $ 134.00 every month will put me way below 0 with bills I pay.


By Evelyn on August 22, 2017

I'm hoping to retire Oct 1, 2017. What do I need to do to sign up for medicare partB? I work for the state and will have medical insurane plus medicare.

Evelyn,
Congratulations on your retirement. Glad you are joining the "family." If depends on your age. You can find out your time to enroll using our FREE Medicare Deadline Calculator. Hope that helps.
-Chris from https://www.senior65.com


By CHERYL on August 14, 2017

My parents... 90 and 86 years old and both with dementia and one with Parkinson's also, have Medicare part A for hospital and part B for medical. Also Mutual of Omaha plan G. They pay their PCP a little over $2200 a year for some "specialized care" that they are not receiving and have still had to pay deductables for services they have received this year. My first question is do you have any idea what this $2200 fee is or what it should be covering or if it is even legal since they have insurance? Also can you recommend something that would help pay for their prescriptions?? Meds for dementia, Parkinson's, blood pressure, cholesterol, etc.?

Cheryl,
This sounds like a Concierge fee. Medicare doesn’t cover membership fees for concierge care but it is legal. Concierge care is when a doctor or group of doctors charges you a membership fee before they’ll see you or accept you into their practice. When you pay this fee, you may get some services or amenities that Medicare doesn’t cover.

According to the CMS Doctors who provide concierge care must still follow all Medicare rules:

1) Doctors who accept assignment can’t charge you extra for Medicare-covered services. This means the membership fee can’t include additional charges for items or services that Medicare usually covers unless Medicare won’t pay for the item or service.

2) Doctors who don’t accept assignment can charge you more than the Medicare-approved amount for Medicare-covered services, but there’s a 15% limit on this charge (Your parent's part G will cover these excess charges).

3) All Medicare doctors (regardless of whether or not they accept assignment) can charge you for items and services that Medicare doesn’t cover.

Hope that helps. As far as drugs go, we can help your parents identify a Medicare Part D plan that coverage some or all of the drugs they are taking.
-Chris from https://www.senior65.com


By Ellen on April 02, 2017

Do Medicare Part A & B cover radiation and chemo treatments for persons over 65 who have opted to take original medicare? thank you

Ellen,
Original Medicare covers chemotherapy. For specific coverage, you will want to contact Medicare directly. If you need help finding a Medicare health plan, call one of our Senior65 licensed independent insurance agents at 800-930-7956.
-Michelle from https://www.senior65.com/


By George Fitzgerald on March 11, 2017

I had two stents put in my heart's arteries. I have ederal insurance. Submitted charges were $86069.86. The plan allowance was $36551.68. Of thisfederal insurance paid $35851.68, leaving me with a co-pay of $700.00. Should my Medicare Part B pay this $700?

George,
You will need to contact your federal insurance provider and Medicare to see if Part B will cover your $700.
-Amy from https://www.senior65.com/


By Lee Sepulvado on September 02, 2015

Am I legally required to have Part A, Part B and Part D Medicare coverages if I obtain medical care and pharmaceuticals from belonging to the VA Medical System? Part B costs over $100 monthly plus co-pays and Part D involves some out of pocket expenses. May I get out of Medicare without penalty and go to the VA only? That is really what I do now except that I am paying to belong to Medicare.

Lee,
Thank you for your questions. Most people are automatically enrolled in Part A, and are not required to pay a premium. Now you can decline Part B and Part D (prescription drug coverage); however, if you choose to enroll later, you will be responsible for a penalty for the months/years you did not have Part B and D, but were eligible.

You can choose to exclusively seek health care through VA facilities, but remember if you want to see a doctor outside of the VA and didn't have Part B, you would have to pay all costs out of pocket. Hope this helps.
-Chris from https://www.senior65.com/


By Felipe on August 13, 2015

From the picture you show a person working out. Does Medicare cover gym memberships? Or is just a picture?

Felipe,
Original Medicare does not cover gym memberships; however Medigap and Medicare Advantage plans can offer the Silver Sneakers program for Medicare enrollees. Silver Sneakers offers free or discounted gym memberships. Hope this helps.
-Eric from https://www.senior65.com/


By Anna Mozian on August 06, 2015

How high is a high income to increase my Part B premium? And does this increase my Part A premium as well? (I'm divorced and make about 90k per year)

Anna,
Part B premiums increase at an income of 85k for an individual. So, if your income stays the same, you would pay an increased amount for Part B only. This does not affect Part A (most people don't pay for the Part A premium, anyway). Hope this helps!
-Michelle from https://www.senior65.com/


By Alex Weaver on July 31, 2015

So the article says that Medicare Part B is optional. Why would anyone not select it??? Who is going to go without Part B? Besides I think I was automatically signed up for B when I turned 65 and the money comes out of my social security payments. Could that be true?

Alex,
Thank you for your question. You may want to delay Part B if you have "creditable" coverage, such as job-based insurance. This way you don't have to pay for the Part B premium and are not responsible for the late penalty.

To answer the second part of your question, if you were automatically signed up Part B, and you did not delay it, the monthly payments generally come out of your social security. Hope this helps.
-Jacima from https://www.senior65.com/



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