Medicare Part B is the medical insurance portion of Original Medicare. It helps pay for doctor visits, outpatient care, preventive services, certain home health services, and medically necessary medical equipment. It also covers some prescription drugs administered in specific medical settings.
Part B has monthly premiums and other out-of-pocket costs. Understanding these expenses and coverage rules can help you plan for healthcare costs after 65. Here is how Medicare Part B works, what it covers, and what beneficiaries should know before enrolling.
What Is Medicare Part B?
Medicare Part B is one of the two main components of Original Medicare, the federal health insurance program for eligible older adults and certain people with disabilities.
Part B is often called medical insurance because it helps cover healthcare services outside traditional inpatient hospital care.
Original Medicare includes two main parts:
- Medicare Part A: Helps cover inpatient hospital care, skilled nursing facility care, hospice care, and certain home health services.
- Medicare Part B: Helps cover doctor services, outpatient care, preventive services, and other medically necessary healthcare.
Medicare also includes Part C, known as Medicare Advantage, and Part D, which helps cover prescription drugs. These options have different rules and coverage arrangements.
Part B is generally available to people eligible for Medicare based on age or qualifying disability. Enrollment rules depend on individual circumstances.
What Does Medicare Part B Cover?
Medicare Part B covers two broad categories of healthcare: medically necessary services and preventive services.
Medically necessary services help diagnose or treat a medical condition. Preventive services help prevent illness or identify health problems early.
Coverage depends on Medicare’s requirements, the service provided, and other applicable conditions.
1. Doctor Visits and Healthcare Providers
Part B covers medically necessary services from doctors and many other healthcare professionals.
Examples include visits with physicians, nurse practitioners, physician assistants, physical therapists, and certain mental health professionals.
Coverage may also include some services from podiatrists, optometrists, and chiropractors under specific conditions.
After meeting the Part B deductible, beneficiaries generally pay 20% of the Medicare-approved amount for most covered professional services.
2. Outpatient Medical Care
Part B helps cover medical services received without an inpatient hospital admission.
Covered outpatient services may include:
- X-rays and certain diagnostic tests
- Medical supplies and casts
- Stitches and wound treatment
- Certain outpatient surgical procedures
- Some hospital outpatient services
The amount a beneficiary pays depends on the service, the facility, and applicable Medicare payment rules. Hospital outpatient care may involve additional copayments.
3. Preventive Services and Screenings
Preventive care is an important part of Medicare Part B.
Covered services may include certain screenings, vaccines, counseling, and preventive visits. Examples include eligible cardiovascular screenings, colorectal cancer screenings, and annual wellness visits.
Many covered preventive services have no out-of-pocket cost when the beneficiary meets Medicare’s requirements and uses a provider who accepts assignment.
However, not every test or examination is free. Diagnostic testing, follow-up appointments, and services beyond the covered preventive benefit may involve additional charges.
Before scheduling a screening, check its coverage conditions and frequency limits through Medicare.gov.
4. Mental Health Services
Part B helps cover certain outpatient mental health services.
These may include individual or group psychotherapy, psychiatric evaluations, and services provided by eligible mental health professionals.
Coverage can depend on the provider, treatment setting, and type of service. Cost-sharing may also apply.
Part B covers certain substance use disorder treatment services when Medicare’s coverage requirements are met.
5. Durable Medical Equipment
Medicare Part B may cover durable medical equipment, or DME, when it is medically necessary and meets Medicare’s requirements.
Examples include:
- Wheelchairs and walkers
- Hospital beds for home use
- Oxygen equipment
- Certain blood glucose monitors and supplies
- Continuous positive airway pressure (CPAP) equipment
A healthcare provider generally must order the equipment. Other eligibility and supplier requirements may apply.
After the deductible, beneficiaries typically pay 20% of the Medicare-approved amount for covered equipment. Depending on the item, Medicare may cover rental, purchase, or a combination of both.
6. Certain Home Health Services
Part B can help cover eligible home health services when Medicare’s conditions are met.
Depending on the circumstances, covered care may include part-time skilled nursing, physical therapy, occupational therapy, and speech-language pathology services.
Home health coverage is not the same as full-time personal care. Medicare generally does not pay for round-the-clock home care or custodial assistance when that is the only care needed.
7. Ambulance Services and Other Medical Care
Part B covers certain medically necessary ambulance services when other transportation could endanger a person’s health.
Coverage may also include eligible clinical research services, oxygen equipment, and certain prescription drugs administered in medical settings.
Prescription drug coverage under Part B is limited. Many prescriptions that people take at home are generally covered through Medicare Part D or another qualifying drug coverage arrangement instead.
