You probably already know that Original Medicare consists of Medicare Part A and Medicare Part B. Significant differences exist, including details on costs and coverage. Some people 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 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.
What Does Medicare Part B Cover?
If you are enrolled in Medicare coverage, you probably wonder, “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.
Doctor Visits
Part B will cover your doctor visits, clinical research, ambulance, and outpatient services.
Medical Equipment
Medicare Part B covers durable medical equipment, such as wheelchairs or other equipment necessary to treat a medical condition.
Mental Health
Part B provides mental health care coverage, including inpatient and outpatient care.
Preventative Services
Regarding 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 others will be covered. For example, Medicare generally pays for an annual mammogram and wellness visit. You should know that Part B coverage is subject to a yearly deductible and copays or coinsurance payments.
Part A – Complementary Coverage
Medicare Part A perfectly complements 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 later in this article.
KEY TAKEAWAYS
- Medicare Part B is also known as medical insurance. It covers doctor visits, ambulance, outpatient services, medical equipment, mental health, and preventative services.
- Even though Medicare Part B covers medical equipment, it does not pay for hearing aids. It does not cover hospital or inpatient care, prescription drugs, dental, vision, or routine chiropractic care.
- Many people think Medicare is free, but that is not the case. All Medicare Part B plans require a monthly premium, plus you will have deductible and copay costs.
What Is Not Covered By Medicare Part B?
Now that you know what Medicare Part B covers, it is helpful to understand some things that Part B does not cover. You might be surprised at some of the items that are not covered.
Hospital + Inpatient Care
First, Part B does not cover hospital stays, inpatient care, most home health care, or hospice care, which are covered by Medicare Part A.
Routine Chiropractic Care
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.
Dental or Vision Care
Many people wonder, “Does Medicare cover dental?” The answer is no. Part B does not provide dental or vision coverage. Routine dental care, like cleaning, filling, or extraction, is not covered.
However, there is a slight 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 necessary for the jaw surgery, then the extraction will be covered by Medicare. Routine eye exams for vision correction are also not covered.
Dentures or Hearing Aids
Although Part B covers durable medical equipment, it does not cover certain items, like dentures or hearing aids. Although you might think a hearing aid would be considered medical equipment, Medicare considers hearing aids to be elective equipment.
Prescription Drug Coverage
Finally, Part B does not provide prescription drug coverage. In some cases, Part B will give limited prescription drug coverage for a medication part of an outpatient service. However, if you need a prescription drug plan, you must sign up for Medicare Part D or a Medicare Advantage plan.
Unapproved Medicare Providers
You should also know that Part B will not cover any services received from a healthcare provider who does not accept Medicare. So, ensure your provider accepts your Medicare coverage before you receive treatment. If your doctor won’t take your Medicare coverage, your Part B plan might not pay for the service.
Must read articles related to Medicare
- Steps to sign up for Medicare
- What is Medicare Part C (Medicare Advantage)?
- Is there a benefit to enrolling in Medicare Part D prescription drug coverage?
- Leveraging the Medicare Part B give-back benefit to reduce premiums.
- When can I enroll in Medicare Supplement plans?
Overview Of The Parts Of Medicare
Medicare consists of several different parts, and it is helpful to understand the differences. While Original Medicare consists of Part A & B, you might also hear people discuss Medicare Part C or D coverage. If you are wondering, “What does Medicare pay for,” the answer often depends on which part of Medicare you are referring to. Here is what you need to know about each part of Medicare.
TIP
Low-income individuals may be able to lower the costs associated with Medicare Part B by qualifying for one of the four Medicare Savings programs, which provide funds to cover premiums, deductibles, and copays.
Cost Of Medicare Part B Coverage
There are several different costs associated with Part B coverage, and here are the main ones.
Monthly Premium Cost
First, you should know that Part B requires a monthly premium payment. The cost of the premium depends on your total annual income. The standard Part B premium for 2025 will be $185. This is the amount that most people will pay. However, if you have a very high income, you could pay as much as $629 monthly for your coverage.
Deductible Cost
In addition to the premium, you will also be responsible for cost-sharing amounts. For 2025, the Part B deductible will be $257. This means you must pay this amount out of your pocket before your benefits start paying for services.
Coinsurance Cost
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.
Medicare Savings Programs
Some assistance programs are available if you cannot afford your Part B Medicare coverage. Medicare Savings Programs are available to help cover a portion of your monthly Part B premium. 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.
Medigap Plans
Some people also enroll in a Medicare Supplement Plan, or Medigap Plan, to help cover their out-of-pocket Medicare costs. Medigap plans help cover out-of-pocket expenses associated with your Medicare coverage, like paying for your coinsurance amount when you receive health services.
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.
Age Eligibility
Eligibility for Medicare requires being 65 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.
Disability Eligibility
Younger individuals receiving Social Security disability benefits for at least 24 months are eligible for Medicare benefits. Similarly, those diagnosed with end-stage renal disease can qualify for Medicare coverage. You can get more details about qualifying for coverage at Medicare.gov.
Enrollment
Enrollment in Medicare coverage is pretty straightforward. You will be automatically enrolled in coverage if you already receive Social Security benefits on your 65th birthday.
Since Medicare Part B requires monthly premium payments, 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 who have not received Social Security yet, you will need to apply for Medicare benefits. You can easily apply for benefits online but must submit a few required documents to start your coverage.
The Bottom Line
Medicare Part B acts like traditional medical insurance, covering doctor visits, outpatient care, durable medical equipment, and ambulance services.
Part B does not cover inpatient, long-term hospital stays, dental, or vision care. In addition, it does not generally cover prescription drugs, except for limited cases as part of outpatient care.
A monthly premium is required for Part B coverage, and you are also responsible for coinsurance amounts on most services.
Frequently Asked Questions
The Medicare Part B deductible for 2025 is $257. 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.
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 low-income people and help pay for costs related to your Part B coverage, like premiums, deductibles, and copays.
Medicare Part B is not full coverage. Many things 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.
Medicare Part B is similar to traditional medical insurance. It covers doctor visits, preventive services, outpatient services, and durable medical equipment. Part B includes a monthly premium, and covered services are subject to a deductible and coinsurance amount.
In many cases, Part B will cover these services at 80%, although some are covered at 100%. For example, preventive services, like covered vaccines, are usually covered at 100%.
You can find a Social Security Administration office near you by using our SSA office locator and searching for your closest location.
