Woman using Medicare Part B - Covers Doctor Visit

What Medicare Part B Covers 

For those who have qualified for Medicare Part A, they are also qualified for Medicare Part B coverage. Individuals over the age of 65 who are already recipients of Social Security funds are automatically enrolled in Medicare Part B, but they can opt-out. To obtain Medicare Part B coverage, one has to pay a premium (monthly fee) that is usually taken out of the Social Security check. In 2020, this fee is $144.60/month. However, for those with a higher household income (single $85K, couple $170K), the monthly premium is higher. In addition, there is an annual deductible fee of $198. After the deductible, Medicare Part B covers nearly 80% of your healthcare costs and you have to pay the other 20%.

All individuals must be aware that there is a penalty for delayed signing up for Part B. For those who don’t sign up when they first become eligible, the monthly fee is higher and there is a 10% penalty for every year that the enrollment is delayed. Some of the coverage of Medicare Part B includes the following:

Medicare Part B Covers Basic Medical

Medicare Part B is a portion of the Original Medicare program that covers healthcare services and supplies that are deemed medically necessary to treat a health disorder. This may include preventive services, outpatient care, durable medical equipment, and ambulance services. In addition, Medicare Part B covers part-time rehabilitation (e.g. physical therapy) and intermittent home health services as long as a physician has ordered them for a medical condition.

Medicare Part B Covers Services from Doctors

Medicare Part B covers the cost of outpatient medical care such as clinic visits, most laboratory tests, some home health services, medications, and medical equipment. Because hospital and skilled nursing facility admissions are covered under Part A, they are not covered by Medicare Part B. In each instance where a test, medication, or medical equipment is ordered, Medicare part B covers the cost as long as there is an order from a licensed physician.

Outpatient care and Other Services Covered by Medicare Part B

Medicare Part B covers a variety of outpatient clinical services that includes screening for cancer (for example: mammogram, colonoscopy), vaccination (such as flu shot), wellness care, and counseling. In addition, part B also covers regular doctor visits, ambulance rides, laboratory testing, x-rays, and some chiropractic care.

  1. Home Health Care: Medicare Part B covers home health care when one meets the eligibility criteria such as having a need for skilled care and being homebound. Unlike Medicare Part A, there is no deductible or coinsurance and no need for prior hospital admission for Medicare Part B coverage for home healthcare. More important, Medicare part B covers home health aides when there is an order from a physician and the assistance is deemed medically necessary. Besides a home health aide, the coverage may also include skilled nursing care, occupational and/or physical therapy.
  2. Durable Medical Equipment: Durable medical equipment includes items like oxygen, wheelchairs, and walkers that are necessary for some individuals to perform their daily living activities. Medicare Part B covers 80% of the cost provided a physician or therapist has approved its usage. The individual must pay the other 20%. It is important to seek a provider who accepts Medicare coverage otherwise the costs can be higher. 
  3. Preventive Services: Medicare Part B covers a wide range of preventive services that include vaccines, cancer screening, cardiovascular screenings, hepatitis B shots, diabetes screenings, and much more. Since the preventive services are recommended by the US Preventive Services Task Force, they are fully covered with zero costs to the individual. However, for other additional services, there is a cost. For example, if the screening colonoscopy reveals a mass, then workup and treatment of this mass are not covered under Part B In addition, it is vital that you see a provider who accepts Medicare Part B or you can be charged if you see a non-participating provider.

What Medicare Part B Does Not Cover

  1. Any expenses related to a hospital admission that are usually covered by Part A. In addition, Medicare Part B covers only prescription medications and not Over the Counter drugs.
  2. Routine hearing, vision, and dental care including dentures and hearing aids.
  3. Routine foot care includes removal of corns, calluses, or toenails unless you have cancer diabetes, chronic kidney disease, disease of your blood vessels, or malnutrition. Footcare is only covered if prescribed by a physician or podiatrist and must be deemed necessary.
  4. Home safety items like stairlifts, bathtub lifts, grab bars in the bathroom, or an emergency alert system. These safety items are only covered if deemed medically necessary and prescribed by a physician.
  5. Assisted living facilities or long-term care in nursing homes. In some cases, Medicare will cover the medical needs but will not pay for custodial care meaning assistance with daily living activities like feeding, dressing, bathing, or eating. Even when Medicare coverage is available, it is only for the short term.
  6. Except in very rare circumstances, medical services outside the continental USA are not covered.
  7. Cosmetic surgery.
  8. Alternative healthcare like yoga, pilates, and acupuncture.

Consider Medicare Part C and D Options

Medicare Part B covers many essential outpatient services, but it is not comprehensive. Thus, the individual should consider getting Medicare Part C and/or Part D. Medicare Part D is a comprehensive prescription drug program that is available from private insurers. One must be enrolled in Part A and/or Part B to be eligible for this program. Medicare Part C is the Medicare Advantage program that provides an alternative method of getting Part A and Part B benefits. This program is available through private insurers and includes prescription drug coverage via Medicare Part D. Plus, Part C also offers other benefits like membership into wellness programs and routine dental services.

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