What are my Medicare Part B benefits?
Summary: Medicare Part B covers most outpatient services, including doctor visits, medical therapies, home health care, and durable medical equipment and preventative services.
If you’re enrolled in Original Medicare, your health coverage comes in two parts: Medicare Part A and Medicare Part B.
Part A is considered hospital insurance; it pays for your inpatient care in a hospital or skilled nursing facility. Medicare Part B covers most outpatient services, including doctor visits, medical therapies, home health care, and durable medical equipment.
Here’s what you need to know about your coverage, costs, and benefits under Medicare Part B.
What outpatient services does Medicare Part B cover?
Medicare Part B covers two types of outpatient services:
- Medically necessary services to diagnose and treat and illness, injury, or disease
- Preventive services to ward off onset of illness or disease and screening to detect conditions early
Obviously, a lot of medical care fall under those two types of services. In most cases, Medicare Part B pays for your doctor visits in both inpatient and outpatient settings, as well as medically necessary specialist care. Medicare Part B also covers second surgical opinions .
Part B also covers physical, occupational, and speech-language therapy in inpatient and outpatient settings, and even as part of a home health care treatment plan. Medicare Part B also has benefits for clinical trials if you are accepted into a research program.
Under the preventive services benefit under Medicare Part B, you have coverage for screenings, tests, and immunizations such as:
- Heart and high blood pressure screenings
- Breast, cervical, colorectal, lung, prostate, and vaginal cancer screenings
- Diabetes tests
- Alcohol abuse screening and counseling
- Obesity screening and weight loss counseling
- Hepatitis screening and vaccines
- Flu and pneumococcal vaccines
- Glaucoma screening
- Depression screening
Does Medicare Part B cover mental health?
Part B covers outpatient mental health services as well as partial hospitalization programs. Covered services include individual and group therapy, medication management, psychiatric evaluations, and diagnostic testing.
Is medical equipment covered by Medicare Part B?
Part B pays for durable medical equipment such as hospital beds, wheelchairs, oxygen tanks, tubing, and supplies, glucose monitors, infusion pumps, nebulizer machines, and CPAP machines. Depending on the type of equipment you need, Medicare Part B may cover the cost to either buy or rent the equipment.
In most cases, medical supplies required for use with covered durable medical equipment are also covered under Part B. Prescription medications for use with durable medical equipment, such as albuterol for a nebulizer machine or insulin for an insulin pump, are also usually covered under Medicare Part B.
Does Medicare Part B cover any prescription medications?
Generally speaking, Part B doesn’t cover prescription medications you take orally at home. There may be some exceptions, however, such as nausea medication for use with chemotherapy, oral end-stage renal disease medications, and immunosuppressant medications after organ transplant.
Part B does generally pay for prescription medications administered in a doctor’s office or other outpatient setting. In most cases, Medicare Part B covers prescription drugs administered by injection or infusion and this includes injection done at home by either you, a family member, or a home health nurse or aide. Some examples include certain osteoporosis injections, clotting factor injections, and some antigens.
What are my costs with Medicare Part B?
Medicare Part B usually includes the following costs:
- Monthly Premium: Everyone typically pays the monthly Part B premium, which is $135.50 in 2019. People at certain income levels also pay an income-related monthly adjustment amount along with the standard premium. Even if you choose to get your Medicare benefits through a Medicare Advantage plan, you will continue to pay your Part B premium.
- Deductible: There is also an annual Part B deductible, which is $185 in 2019.
- Coinsurance/Copayment: Cost-sharing under Medicare Part B depends on the service. For most outpatient services and durable medical equipment, the coinsurance amount is 20% of the Medicare-approved amount. Some outpatient services have a flat copayment, such as outpatient counseling in a hospital setting.
- Out-of-pocket costs: There are no caps on your out-of-pocket spending under Original Medicare. You pay 20% of the allowable charges, regardless of how much health care you use each year.
How can I lower my out-of-pocket costs with Medicare Part B?
Some people find that choosing a Medicare Advantage plan for their Medicare benefits is a more cost-effective option.
Medicare Advantage plans operate more like employer health plans:
- you have one annual deductible instead of Part A and Part B deductibles
- most services have a flat copayment instead of a percentage-based coinsurance
- you also have a maximum out-of-pocket limit each year. Once you reach that amount on covered services, your plan pays 100% of your expenses.
If you stick with Original Medicare, you can buy a Medicare Supplement Insurance Plan to help cover your share of covered expenses. The most comprehensive plans cover all of your Part A and Part B coinsurance amounts and 100% of your Part A deductibles. Although plans covering your Part B deductible are available until December 31, 2019, they will no longer be sold as of January 1, 2020.
To find a Medicare Advantage plan with Medicare Part B coverage included, enter your ZIP code on this page.