You probably already know that Original Medicare consists of both Medicare Part A and Medicare Part B. There are significant differences between the two, including costs and coverage details. Some people choose to opt out of Part B coverage, which means they will lose coverage for some critical medical services. Before you decide whether to enroll in Medicare Part B or opt-out of that coverage, you need to know the details of what a Medicare Part B insurance plan includes. So, keep reading as we tell you what Part B covers, what it doesn’t cover, and how much it will cost you.
What Does Medicare Part B Cover?
If you are enrolled in Medicare coverage, you are probably wondering, “What does Medicare cover?” Medicare Part B is considered similar to traditional medical insurance. At a high level, Part B covers medically necessary services and preventive services. These two things include many types of medical procedures. Part B will cover your doctor visits, clinical research, ambulance services, and most outpatient services.
In addition, Medicare Part B covers durable medical equipment. This type of equipment could include wheelchairs or other equipment that is medically necessary for the treatment of a medical condition. Part B provides coverage for mental health care, including both inpatient and outpatient care. When it comes to preventive services, Part B will cover many vaccines and other preventive care, like flu shots and pneumonia shots. Screenings and lab tests for diabetes, heart disease, cancer, glaucoma, and other things will be covered. For example, Medicare will generally pay for an annual mammogram and an annual wellness visit. You should be aware that Part B coverage is subject to an annual deductible and copays or coinsurance payments.
Medicare Part A is the perfect complement to Part B coverage because Part A covers inpatient care. Part A is considered hospital insurance because it pays for hospital stays, short-term care in a skilled nursing facility, and other inpatient services. These two parts of Medicare work together to cover a wide range of medical services, and we will discuss more specific differences between the two later in this article.
What Is Not Covered By Medicare Part B?
Now that you know what is covered by Medicare Part B, it is helpful to understand some of the things that Part B does not cover. You might be surprised at some of the items that are not covered. First, Part B does not cover hospital stays, inpatient care, most home health care, or hospice care. These items are covered by Medicare Part A. Part B also does not cover all chiropractic care. While it does cover spinal subluxation by a chiropractor, it will not cover X-rays or other tests ordered by your chiropractor.
Many people wonder, “Does Medicare cover dental?” The answer is no. Part B does not provide dental or vision coverage. Routine dental care, like a cleaning, filling, or extraction, is not covered. However, there is a small exception to this rule. If the dental service is required as part of a medically necessary service covered by Part B, then the dental service will be covered. For example, suppose you are in a car accident and require immediate jaw surgery. If a tooth extraction is required as part of the jaw surgery, then the extraction will be covered by Medicare. Routine eye exams for vision correction are also not covered.
Although Part B covers durable medical equipment, it does not cover certain items, like dentures or hearing aids. You might think a hearing aid would be considered medical equipment, but Medicare considers hearing aids to be elective equipment. Finally, Part B does not provide prescription drug coverage. In some cases, Part B will provide limited prescription drug coverage for a medication that is part of an outpatient service. However, if you need a prescription drug plan, you will need to sign up for Medicare Part D or a Medicare Advantage plan.
You should also know that Part B will not cover any services received from a healthcare provider who does not accept Medicare. So, make sure that your provider will accept your Medicare coverage before you receive treatment. If your doctor won’t accept your Medicare coverage, then your Part B plan might not pay for the service.
Eligibility For Medicare Part B
So, who is eligible for Medicare health insurance? Eligibility for Medicare Part B is the same as eligibility for Part A coverage. Eligibility for Medicare requires that you are 65 years of age or older and a U.S. citizen. Permanent residents can also qualify for Medicare Part B if they have lived in the United States for at least five consecutive years. There is also a way that younger individuals can qualify for Medicare.
Younger individuals receiving Social Security disability benefits for at least 24 months are eligible for Medicare benefits. Similarly, those who are diagnosed with end-stage renal disease can qualify for Medicare coverage. You can get more details about qualifying for coverage at Medicare.gov.
Enrollment in Medicare coverage is pretty easy. If you are already receiving Social Security benefits on your 65th birthday, you will be automatically enrolled in coverage. Since Medicare Part B does require the payment of a monthly premium, you can opt-out of this coverage. However, if you decide to sign up after your initial enrollment period, you might be stuck paying a late enrollment penalty. For those not receiving Social Security yet, you will need to apply for Medicare benefits. You can easily apply for benefits online, and you will just need to submit a few required documents to start your coverage.
Cost Of Medicare Part B Coverage
There are a few different costs associated with Part B coverage, and here are the main ones you need to know about. First, you should know that Part B requires the payment of a monthly premium. The cost of the premium depends on your total annual income. The standard Part B premium for 2023 will be $164.90. This is the amount that most people will pay. However, if you have a very high income, you could pay as much as $560.50 per month for your coverage.
In addition to the premium, you will also be responsible for cost-sharing amounts. For 2023, the Part B deductible will be $226. This means that you will need to pay this amount out of your pocket before your benefits start paying for services. Once you reach your deductible, you will be responsible for a 20% coinsurance amount for most services. This means that Medicare will pay for 80% of the price of the covered service, while you will be responsible for the remaining 20%. There are a few things that Part B covers 100%, such as some vaccines and other preventive services.
If you cannot afford your Part B Medicare coverage, there are some assistance programs available. Medicare Savings Programs are available to help cover a portion of your Part B premium each month. You should contact your state Medicaid office to learn more about these programs. These programs are typically managed through the Medicaid office in your state because they are joint federal and state programs.
Some people also choose to enroll in a Medicare Supplement Plan, or Medigap Plan, to help cover their out-of-pocket Medicare costs. Medigap plans help cover the cost of out-of-pocket expenses associated with your Medicare coverage, like paying for your coinsurance amount when you receive health services.
Original Medicare — Difference Between Medicare Part A & Part B
We have already briefly touched on the differences between Medicare Part A and Part B, particularly when it comes to coverage details. Medicare Part A generally covers inpatient hospital care and mental health care, while Part B covers doctor services, outpatient services, and preventive services. In addition to differences in the coverage details, there are also differences in the costs of these plans.
Many people qualify for premium-free Part A coverage. As long as you have enough work credits, you will not pay a monthly premium for your Part A coverage. Generally, this requires working and paying Medicare taxes for at least ten years. If you do not qualify for premium-free coverage, you might pay as much as $499 per month for coverage. Part B, on the other hand, always requires the payment of a premium. The more money you make, the higher your Medicare Part B premium will be. The premiums for Part B cost $164.90 per month for most people.
Other Medicare Coverage Options
You should now be informed of the things that are covered by Medicare Part B, as well as the items that are not covered. Unfortunately, there are many services that are not covered by Medicare at all. So, what other options are out there to help with coverage for those items? Here are some additional Medicare coverage options that might make sense for your situation.
— Medicare Part C
Medicare Part C, or Medicare Advantage, is a health plan that combines both Medicare Part A and Part B. These plans are managed by private insurance companies, which contract with Medicare to provide coverage. These plans must provide the same minimum level of coverage as Original Medicare, although most Medicare Advantage plans provide additional benefits.
Many Advantage plans include both dental and vision coverage. Most of the plans also include prescription drug coverage. The plans available to you will depend on the area where you live, but you can use the Medicare plan finder tool to search for a plan in your area that fits your needs. Be aware that you cannot switch to an Advantage plan at any time. You will need to sign up during your initial enrollment period, the open enrollment period (general enrollment period), or a special enrollment period.
— Medicare Part D
If you don’t need all the bells and whistles of a Medicare Advantage plan, you might consider simply adding a Part D prescription drug plan to your coverage. Again, these plans are managed by private insurance companies, and they provide coverage for your prescription medications. Most Part D insurance plans include a formulary, and the plans generally only cover medicines included on the formulary list.
— Medicare Supplement Insurance
Some Medicare beneficiaries choose to sign up for a Medicare Supplement plan with Original Medicare. These plans are also called Medigap plans. These plans help cover out-of-pocket costs not covered by Original Medicare. One of the biggest things these plans cover is your coinsurance amount, but these plans can also help cover other expenses as well. You can visit www.Medicare.gov to learn more about the Medigap plans available.
The Bottom Line
Medicare Part B acts like traditional medical insurance, and it covers things like doctor visits, outpatient care, durable medical equipment, and ambulance services. Part B does not cover inpatient care, long-term care, hospital stays, dental care, or vision care. In addition, Part B does not generally cover prescription drugs, except for limited cases as part of outpatient care. There is a monthly premium required for Part B coverage, and you are also responsible for coinsurance amounts on most services.
Frequently Asked Questions
What is Medicare Part B’s deductible?
The Medicare Part B deductible for 2023 is $226. You must meet your deductible before Medicare begins paying for covered services. This amount is annual, so unlike your Part A deductible, you do not need to worry about benefit periods. In addition to the deductible, you will also be responsible for a monthly Part B premium and coinsurance payments for covered services. When choosing the Medicare plan that is right for you, make sure that you consider the total cost of the plan and not just the premium.
What does Medicare Part B entitle you to?
Medicare Part B entitles you to coverage of outpatient services, doctor visits, preventive services, and other items under your Medicare plan. Enrollment in Part B could also entitle you to benefits under a Medicare Savings Plan if you qualify. These savings plans are available for people with low income, and they help pay for costs related to your Part B coverage, like premiums, deductibles, and copays.
Is Medicare Part B full coverage?
Medicare Part B is not full coverage. There are many things that are not covered by Medicare Part B. For instance, dental and vision benefits are not included with Part B coverage. Similarly, Part B does not pay for inpatient services, hospice care, or most home health care. Most items covered by Part B also require a 20% coinsurance amount. This means that you will be responsible for paying 20% of the cost of the service.
What does Medicare Part B cover?
Medicare Part B covers doctor visits, outpatient services, wellness visits, and preventive services. These services might include flu vaccines, pneumonia vaccines, mammograms, and screenings for many other health conditions. Remember that your Part B coverage is subject to an annual deductible and coinsurance payments each time you get medical treatment.