What does Medicare Part B cover?

Medicare Part B covers visits to the doctor and medically necessary health care services. It also covers some wellness and preventive care like flu shots. You may go to any qualified health care provider or doctor in the United States who participates in the Medicare program and is accepting Medicare patients. The following list shows examples of services covered by Part B:


Medicare Part B covers doctor visits and outpatient care, including:
  • Doctor visits, including doctor services in the hospital
  • An annual wellness visit
  • Some preventive services, like flu shots and screening mammograms
  • Lab services, such as blood tests
  • X-rays and some other diagnostic tests
  • Some health programs, like cardiac rehab, smoking cessation and obesity counseling
  • Outpatient physical and occupational therapy, and speech-language pathology services
  • Diabetes screenings, diabetes education and certain supplies for diabetes management
  • Mental healthcare
  • Durable medical equipment for home use, like walkers and wheelchairs
  • Ambulatory surgery center services
  • Emergency room and ambulance services
  • Skilled nursing care and health aide services for the homebound on a part-time schedule or intermittent basis

What does Medicare Part B cost?

Medicare Part B shares some costs with you when you visit the doctor or have other medical services. Part B also charges a monthly premium. If you receive Social Security benefits, your premium payment is deducted from your monthly check. Otherwise, you need to send a monthly premium payment to Medicare. The following table outlines the different costs that may apply (costs shown are for 2020).


Premium:
Per month: $144.60 to $491.60 depending on income
  • Your monthly premium may be less than $144.60 if you enrolled in Part B in 2018 or earlier and your payments are deducted from your monthly Social Security checks.
  • Your monthly premium could be more than $144.60 if your reported adjusted gross income from 2018 was more than $87,000 for individuals or $174,000 for couples.
Deductible:
Per year: $198

Co-insurance:
Most medical services: 20% of the Medicare-approved amount
Durable medical equipment: 20% of the Medicare-approved amount
Outpatient mental health care: 20% of the Medicare-approved amount

Part B may charge a premium penalty if you do not sign up when you are first eligible, unless you qualify for a Special Enrollment Period.

How Medicare Part B cost sharing works

Medicare Part B pays 80% of the cost and you pay 20% for most outpatient care and services. However, there is something called “Medicare assignment” that you should understand as it could impact what you pay.


Doctors and providers who accept Medicare assignment agree to take what Medicare pays (the Medicare-approved amount) as payment in full. Doctors or providers who don’t accept Medicare assignment may charge more than the Medicare-approved amount and you may have to pay an additional cost, called “excess charges.”

Enrolling in Medicare Part B

All individuals who already receive Social Security benefits are automatically enrolled in Original Medicare (Parts A and B) when they reach the age of 65. People turning 65 who are not collecting Social Security need to enroll themselves during their Initial Enrollment Period.


Some people who have other coverage, such as employer health insurance, may choose to delay Part B enrollment and save on paying the premium. It’s a good idea to talk with your plan benefits manager about how your plan might work with Medicare.


People on disability are automatically enrolled in Original Medicare (Parts A and B) after receiving Social Security Disability Income (SSDI) for 24 months. If you have Lou Gehrig’s Disease (ALS), you are automatically enrolled in Original Medicare (Parts A and B) the first month you start to receive SSDI.