What Does Medicare Part B Cover?

Original Medicare Part B Costs and Coverage Explained

by Ray Wilson+ on Feb 11, 2018 | 16 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 Deborah on August 17, 2018

My husband will have knee replacement surgery soon. He has company insurance that has a 5,000.00 deductible and then pays 80%. If he has Medicare parts A and B, will it either of them cover the deductible and/or 30% amount not paid by his company insurance?

Deborah
If your husband has both Medicare and insurance through his employer, one will serve as the primary payer (usually Medicare) and the other as the secondary. The claims process varies based on the type of plan and size of his employer. Please check with your husband's company insurance to see how will handle payment of claims.

If, in the future, he would like to switch to a Medigap plan that has no deductible, please give us a call. We can help compare prices and enroll right over the phone.
-Chris from Senior65.com


By Mel on August 03, 2018

i am 65 and choosing a supplemental plan to my original medicare. My doctor says in the near future I may need to have a pacemaker. I am uncertain which of the supplemental plans to choose. A-N. I assume this would require some hospitalization. I am thinking of a B plan which covers Basic, and Part A deductible and 100% Part B coinsurance. Most of this is quite confusing to me, but is this the best choice for someone in my situation?

Mel,
If your doctor determines that a pacemaker is medically necessary, Medicare should cover all but 20% of the Medicare-approved costs for the pacemaker. You would also need to pay the deductible amount before Medicare covers any part of the pacemaker costs and could be subject to "excess charges" should your doctor apply them.

Selecting the right Medigap plan could cover the 20% not covered as well as your Medicare deductible. We would suggest considering at Medigap plan F or G since they include coverage for excess charges. You can get a quote here. If you would like to discuss more, please contact us at 800-930-7956.
-Michelle from Senior65.com


By Anthony on July 29, 2018

I am 63 and plan to retire once I can maximize my SS benefits. At retirement, I have the option of paying a lump sum payout from my S & I Account to get medical insurance for life for me and my family. It would mirror the insurance my employer offers now, which is a very good plan. I’m thinking I may not need to pay for Medicare B since I should be covered under my Company plan. But I’m not sure about that? Might there be costs that Medicare B might cover that my current policy won’t? I understand this might be a difficult question to answer without fully understanding my policy. But maybe you can respond in general terms? It is all extremely confusing.

You are correct Anthony, we would have to learn more about your plan before recommending a course of action. In general many people postpone Part B to stay on their coverage via work and are happy with that choice. Give us a call to discuss more.
-Chris from Senior65.com


By Lee on July 27, 2018

My question is regarding Silver Sneakers. I’m retired and I have Medicare already with part A and B. Medicare is my primary insurance and Blue Cross Blue Sheild is my secondary insurance with my employer. I’m caring insurance on my spouse and son still with my employer to keep them cover. What will it cost extra to add Medigap to become part of the Silver Sneakers offer. Already paying $134.00 a month for Medicare Part B. Adding Medigap will this kick my family out of the coverage I have with my employer? I was told if I added Medicare Advantage that this will happen

Lee, It is our understanding that one could have a Medigap plan in addition to a employer sponsored plan, it rarely makes sense to do so. Medigap plan prices vary by state and age but for one that offers Silver Sneakers that could be an additional $200 a month. Feel free to call us to help you run the numbers and enroll in a plan if necessary.
-Chris from Senior65.com


By Adelmo on July 16, 2018

Does plan B cover yearly preventive Gyn exams (breast and pelvic) without Pap test? Also how often is Pap test and mammogram covered after age 65?

Adelmo, Medicare does not cover annual GYN exams unless you are high risk.

Every 24 months they cover Pap tests and pelvic exams to check for cervical and vaginal cancer. As part of the exam, Part B also covers a clinical breast exam to check for breast cancer.

If you are at high risk for cervical or vaginal cancer or you’re of childbearing age and have had an abnormal Pap test in the past 36 months, then you can get yearly exams covered.
-Michelle from Senior65.com


By Gene on July 13, 2018

I am just turning 65 in Nov. They have already enrolled me in Medicare and sent my card. My question is about the part D penalties if you don't sign up for part D. I plan on getting a medicare advantage policy which has drug coverage, does this count as getting medicare D?

If your MA plan covers drugs then you do not need to purchase part D and you will not be penalized.

Hope that helps. If you want to compare MA plans during open enrollment (10/15-12/7) please give us a call. There is never a fee and we guarantee the lowest price allowed by law.
-Eric from Senior65.com


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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