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Covered Services Under Medicare Part B

Medicare Part B helps cover preventive services (like medical checkups and screenings) and medically necessary services (like supplies or services you need to treat a medical condition). See the table below for an overview of some of Medicare Part B benefits and services.

Note that there may be limits and restrictions to these covered services (such as how much of a supply you can get, and how often you can get it). Your Medicare Part B deductible often applies to these services. In some cases you might need to make a 20% copayment, depending on what other coverage you might have (such as a Medicare Advantage plan or a Medicare Supplement Plan).

The list of services Medicare Part B covers is long and is subject to change. The list above is not a complete list. Medicare.gov maintains this information at http://www.medicare.gov/coverage/your-medicare-coverage.html.
Ambulance Services If you need transportation for a medical emergency or special condition, Medicare Part B covers it in many cases.

  • Medicare Part B covers ground ambulance transportation when you need to be taken to a hospital or skilled nursing facility for medically necessary services, and when transportation in any other vehicle could endanger your health.
  • Medicare may pay for ambulance transportation in an airplane or helicopter to a hospital if you need emergency transit that ground transportation can't provide.
  • Medicare may pay for limited non-emergency ambulance transportation if you have orders from your doctor saying that it's medically necessary.
  • Medicare will only cover services to the nearest appropriate medical facility that is able to give you the care you need.
Cardiac Rehabilitation Medicare Part B covers approved exercise, education, and counseling programs for patients who meet certain conditions. Medicare Part B also covers intensive cardiac rehabilitation programs that are more rigorous than regular cardiac rehabilitation programs.
Chiropractic services (limited) These services can help correct a subluxation (when one or more of the bones of your spine move out of position) using manipulation of the spine. You have to pay all costs for any other services or tests ordered by a chiropractor.
Diabetes self-management training This class shows you how to manage your diabetes and reduce the risk of complications.
Diabetes Supplies

Covered supplies can include blood sugar test strips and testing monitors; lancet devices and lancets; blood sugar control solutions; and therapeutic shoes and inserts (in some cases). Medicare Part B covers insulin only if used with an external insulin pump.

You need to order your diabetes supplies from a National Mail-Order Program if you buy them at a store or outside this program, in most cases you will pay for the supplies.

Medicare Part D may cover insulin and certain medical supplies used to inject insulin, such as syringes, and some oral diabetic drugs.

Durable Medical Equipment (such as walkers)

Durable medical equipment (DME) refers to things such as oxygen equipment and supplies, wheelchairs, walkers, and hospital beds ordered by a Medicare doctor for use in the home. You might need to rent some items.

You must get your covered equipment or supplies and replacement or repair services from a Medicare-approved supplier.

Medicare has started a program called "competitive bidding" to ensure better cost and quality control for DME. The program will be implemented nationwide by 2016. In some areas of the country, you must use specific suppliers, or Medicare won't pay for the item. It's important to see if you're affected by this program to ensure Medicare payment and avoid any disruption of service. In those areas, you need to use specific suppliers for Medicare to pay for the certain DME, such as:

  • Oxygen supplies and equipment
  • Standard power wheelchair, scooter, and related accessories
  • Certain complex rehabilitative power wheelchairs and related accessories
  • Mail-order diabetes supplies
  • Enteral nutrients, equipment, and supplies
  • Hospital beds and related accessories
  • Continuous Positive Airway Pressure (CPAP) devices and Respiratory Assist Devices (RADs) and related supplies and accessories
  • Walkers and related accessories
  • Support surfaces including certain mattresses and overlays

To find an approved supplier, visit the Medicare-approved Supplier Directory page. Follow the instructions to display a list of approved DME suppliers for your needs.

In some cases, you may continue to get DME from a supplier you've been using for a long time. If you have any questions about what's covered or about suppliers, you can call:

  • Call 1-800-MEDICARE (1-800-633-4227), available 24 hours a day, seven days a week. TTY users should call 1-877-486-2048.
  • Your State Health Insurance Assistance Program (SHIP).
  • Emergency room services When you have an injury, a sudden illness, or an illness that quickly gets much worse, Medicare Part B pays for some or all of most emergency room services.
    Eyeglasses (limited) Generally, glasses and contact lenses are not covered. Medicare Part B does cover one pair of eyeglasses with standard frames (or one set of contact lenses) after cataract surgery.
    Hearing and balance exams These exams are covered if your doctor orders hearing and balance tests to see if you need medical treatment. Medicare Part B doesn't cover hearing aids or exams for fitting hearing aids.
    Kidney dialysis services and supplies For beneficiaries with End-Stage Renal Disease (ESRD), Medicare covers dialysis either in a facility or at home when your doctor orders it.
    Mental health care (outpatient)

    For help with mental health conditions such as depression or anxiety, these services might include visits with a provider such as a:

    • Psychiatrist
    • Licensed alcohol and drug counselor
    • Clinical psychologist
    • Nurse practitioner
    • Clinical nurse specialist
    • Clinical social worker

    These services generally given outside a hospital, or in a hospital outpatient setting (Medicare Part A covers inpatient mental health care).

    Medicare also covers substance abuse services and lab tests, but certain limits and conditions apply.

    What you pay will depend on whether you're being diagnosed and monitored or whether you're getting treatment—and on what other coverage you might have besides Original Medicare, Part A and Part B.

    Talk to your doctor if you feel sad, have little interest in things you used to enjoy, feel dependent on drugs or alcohol, or have thoughts about ending your life.

    Occupational therapy These services involve evaluation and treatment to help you return to usual activities (such as dressing or bathing) after an illness or accident when your doctor certifies you need it.
    Outpatient medical and surgical services and supplies

    Medicare Part B covers approved services and procedures (like X-rays, casts, and stitches).

    For each service, you will probably have to pay at least some of the costs.

    • You pay the doctor 20% of the Medicare-approved amount for the doctor's services.
    • You pay the hospital a copayment for each service you get in a hospital outpatient setting.
    • For each service, the copayment can't be more than the Medicare Part A hospital stay deductible.
    Physical exams

    Medicare covers routine physical, or “wellness,” exams.

    • A “Welcome to Medicare” physical exam is a one-time review of your health. It includes education and advice about preventive services, and referrals for other care if needed. Medicare will cover this exam if you get it within the first year that you have Medicare Part B. You pay nothing for the exam if the doctor accepts assignment.
    • A yearly "Wellness" exam is covered once a year, after your first year of Medicare Part B coverage. At this visit, the doctor works with you to develop or update a personalized prevention plan based on your current health and risk factors. You pay nothing for the Wellness exam if the doctor accepts Medicare assignment.
    Physical therapy Physical therapy is evaluation and treatment for injuries and diseases that change your ability to function when your doctor orders it for you. Medicare Part B covers a limited number of physical therapy sessions.
    Prescription drugs (limited)

    Medicare Part B covers a limited number of drugs, such as:

    • Injections you get in a doctor's office
    • Certain oral cancer drugs
    • Drugs used with some types of durable medical equipment (like a nebulizer or external infusion pump)
    • Under very limited circumstances, certain drugs you get in a hospital outpatient setting

    If the covered drugs you get in a hospital outpatient setting are part of your outpatient services, you pay the copayment for the services. However, if you get other types of drugs in a hospital outpatient setting (sometimes called "self-administered drugs" or drugs you would normally take on your own), what you pay depends on whether you have Medicare Part D or other prescription drug coverage, whether your drug plan covers the drug, and whether the hospital's pharmacy is in your drug plan's network. Contact your prescription drug plan to find out what you pay for drugs you get in a hospital outpatient setting that aren't covered under Medicare Part B.

    Other than the examples above, you pay 100% for most prescription drugs, unless you have Part D or other drug coverage.

    Prosthetic and orthotic Items These items include things like arm, leg, back, and neck braces; artificial eyes; artificial limbs (and their replacement parts); some types of breast prostheses (after mastectomy); and other prosthetic devices. They are generally considered to be durable medical equipment.
    Pulmonary rehabilitation Medicare covers a comprehensive pulmonary rehabilitation program if you have moderate to very severe chronic obstructive pulmonary disease (COPD) and have a referral from the doctor treating your chronic respiratory disease.
    Rural health clinics and free or low-cost health clinics The government sets up clinics to make sure health care is available in areas that don't have many options. These clinics serve beneficiaries in rural and in low-income areas. They are called Federally Qualified Health Centers.
    Screenings (tests and scans)

    Medicare covers many screenings that can prevent common serious illnesses or conditions. Some examples of the covered screenings are:

    • Abdominal aortic aneurysm
    • Bone mass measurement (bone density)
    • Cardiovascular disease
    • Colorectal cancer
    • Diabetes
    • Glaucoma
    • HIV/AIDS
    • Mammograms
    • Prostate cancer

    Medicare Part B also covers X-rays, MRIs, CT scans, EKGs, and some other diagnostic tests. If you get the test at a hospital as an outpatient, you also pay the hospital a copayment that may be more than 20% of the Medicare-approved amount, but it can't be more than the Medicare Part A hospital stay deductible.

    There are some limitations and restrictions on these screenings (for example, how often Medicare will pay for them). Some screenings are free. For others, you might pay 20% of the Medicare-approved amount, and the Part B deductible applies for the doctor's visit. In a hospital outpatient setting, you also pay the hospital a copayment. The amount you pay also depends on what other coverage you may have, such as a Medicare Supplement Plan.

    Second surgical opinions For non-emergency surgery, Medicare Part B covers some second opinion consultations. In some cases, Medicare covers third surgical opinions.
    Shots

    Medicare Part B pays for the following vaccinations:

    • Flu shot once per flu season (fall or winter).
    • Pneumonia shot (usually needed only once in a lifetime)
    • Hepatitis B shot, for those at risk for the disease.

    Smoking cessation (help to quit smoking)

    If you're diagnosed with an illness caused or complicated by tobacco use, or you take a medicine that is affected by tobacco, this service includes up to eight face-to-face visits in a 12-month period.

    If you haven't been diagnosed with an illness caused or complicated by tobacco use, this is now considered a covered preventive service. Medicare Part B benefits cover up to eight face-to-face visits with a Medicare-recognized practitioner in a 12-month period.

    Speech therapy Also known as speech-language pathology services, these benefits involve evaluation and treatment to regain and strengthen speech and language skills. They can include cognitive and swallowing skills when your doctor certifies you need them.
    Telehealth In certain situations, you can visit with a doctor who's in a different location than you are, using an interactive two-way telecommunications system (like real-time audio and video). Telehealth services are available in some rural areas, if you're located at one of the following places: a doctor's office, hospital, rural health clinic, federally qualified health center, hospital-based dialysis facility, skilled nursing facility, or community mental health center.
    Transplants and immunosuppressive drugs

    In some situations, Medicare Part B coverage includes doctor services for organ transplants, and cornea transplants under certain conditions.

    Immunosuppressive drugs are covered if Medicare paid for the transplant, or an employer or union group health plan was required to pay before Medicare paid for the transplant. You must have been entitled to Medicare Part A at the time of the transplant, and you must be entitled to Medicare Part B at the time you get immunosuppressive drugs.

    Medicare Part A covers other transplant services, including some organ transplant.

    If you need a transplant, or are on a transplant waiting list:

    • Talk with your provider about making sure the services are covered.
    • If you're thinking about joining a Medicare Advantage plan and are on a transplant waiting list or believe you need a transplant, check with the plan before you join to make sure your doctors and hospitals are in the plan's network.
    • Check the plan's prior authorization requirements.

    Medicare drug plans (Part D) may cover immunosuppressive drugs, even if Medicare or an employer or union group health plan didn't pay for the transplant.

    Travel (health care needed when traveling outside the United States)

    Medicare generally doesn't cover health care while you're traveling outside the U.S. The U.S. includes:

    • The 50 states
    • The District of Columbia (Washington, D.C.)
    • Puerto Rico
    • The Virgin Islands
    • Guam
    • The Northern Mariana Islands
    • American Samoa

    There are some exceptions, including some cases where Medicare may pay for services that you get while on board a ship within U.S. territorial waters.

    Medicare may pay for inpatient hospital, doctor, or ambulance services you get in a foreign country if the hospital is closer than the nearest U.S. hospital that can treat your medical condition.

    Medicare may cover medically necessary ambulance transportation to a foreign hospital, but only if you're admitted for Medicare-covered inpatient hospital services.

    Urgently needed care Medicare Part B covers treatment of a sudden illness or injury that isn't a medical emergency.

    Medicare has neither reviewed nor endorsed this information.

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