What Medicare Part B Covers
Medicare Part B covers outpatient/medical services, some of which are subject to a deductible and a copay, but many are free.
Preventive Services
Preventive health care services are typically free provided that you see a doctor or health care provider who accepts assignments. This means that they’ll accept the Medicare-approved amounts as full payment. These are services that help to prevent illness, keep you healthy, and detect conditions, including:
Bone density measurementsCardiovascular disease screeningsMammogramsCancer screenings (such as for cervical, colorectal, or prostate)Depression screeningsDiabetes screeningsFlu shotsGlaucoma tests if you’re considered to be at high risk for this diseaseA yearly “wellness” visit
Other Medically Necessary Services
Additionally, Medicare Part B helps to cover other services or supplies that are necessary to treat or diagnose a medical condition, including services from doctors or health care providers, outpatient care, home health care, and durable medical equipment. Here are some examples:
Ambulance services Cardiac rehabilitation A portion of outpatient chemotherapy Implanted defibrillator Diabetes supplies Durable medical equipment like oxygen equipment, wheelchairs, and walkers Certain types of medically necessary home health services Kidney dialysis and supplies Physical therapy Second surgical opinions Tests such as MRIs, CT scans, EKG/ECGs, and a CPAP trial for up to three months if you’ve been diagnosed with obstructive sleep apnea Lab services, such as blood tests, urinalysis, and tests on tissue samples
This isn’t an exhaustive list. Additional services may also be covered. Unlike preventive services, these often come with a deductible and a copay of 20% of the Medicare-approved cost. There’s no yearly limit on how much you may have to pay out-of-pocket for health care services with Part B.
What Isn’t Covered by Medicare Part B
Medicare Part B doesn’t cover expenses that are covered by other parts of Medicare, such as inpatient care in hospitals, skilled nursing facility care, hospice care, and prescription drugs. There are also a few notable types of care not covered. Most dental care, including dentures, is not covered under any portion of Medicare Parts A and B. Eye exams related to prescribing glasses (but not to an illness or issue), cosmetic surgery, hearing aids, fitting exams related to hearing aids, and concierge services aren’t covered under Medicare Parts A and B. You won’t find long-term care as a covered service.
Long-Term Care
Also known as “custodial care,” long-term care is non-medical care related to the six activities of daily living: bathing, dressing, eating, transferring, toileting, and continence. This lack of coverage isn’t unique to Medicare Parts A and B. Most health insurance plans, including Medigap coverage, don’t cover these services, according to the Centers for Medicare and Medicaid Services. Medicare Part A does cover a portion of the costs for skilled nursing home care, but only as an inpatient and not on a long-term basis. Many people need skilled nursing home care due to a disability or disease, but they don’t meet the minimum hospital stay requirement. You can’t count on Medicare Part A or Part B to cover nursing home or long-term care expenses if this describes your situation.
Medicare Advantage (MA) Plans
Medicare Advantage (MA) Plans, also known as Medicare Part C, are health care plans from private companies that are approved by Medicare. They include Medicare Part A and B, and typically also include Part D along with other benefits that Medicare plans lack. For example, it’s common for MA plans to include vision, hearing, and dental services. They may also offer lower out-of-pocket costs with a yearly out-of-pocket limit. However, they typically require that you use doctors in the plan’s network.
How To Enroll in Medicare Part B
Ready to enroll in Medicare Part B? Here are the steps to follow:
Check Your Eligibility
Before you enroll in any part of Medicare, you have to be eligible. You usually become eligible three months before you turn 65. However, you may also be eligible earlier if you are disabled or have ESRD or ALS. Additionally, you must be entitled to benefits based on your earnings, or the earnings of a child, spouse, or parent.
Apply for Medicare
You’ll have three options for applying when you’re eligible if you’re not automatically enrolled: You’ll be automatically enrolled in premium-free Part A coverage and can choose if you want Part B if you apply for Social Security or RRB benefits. You can apply for Medicare or Medicare with Social Security benefits on the SSA’s website, by phone at 1-800-772-1213, or at your local Social Security office. If you or your spouse worked for a railroad, you can apply for RRB benefits by contacting the Railroad Retirement Board at 1-877-772-5772.
Enroll During an Enrollment Period
You can only enroll in Medicare Part B during an initial enrollment period, a general enrollment period, or a special enrollment period.
Initial enrollment period (IEP): A seven-month period that starts three months before you turn 65 and ends three months after. General enrollment period: An annual enrollment period that runs from Jan. 1 to March 31. Beginning Jan. 1, 2023, coverage begins the month after you sign up.Special enrollment period: An eight-month period that starts when employment or group health plan coverage ends.
