What does Medicare Part B cover?
A detailed look at what’s covered under Medicare Part B
Original Medicare consists of two parts: Medicare Part A and Medicare Part B.
Medicare Part A is hospital insurance that covers inpatient care in a hospital, skilled nursing facility care, nursing home, hospice and some home health care.
Medicare Part B is medical insurance that covers outpatient care, like doctor’s visits and lab testing. It also covers preventive care such as flu shots, colonoscopies and mammograms.
There is a monthly premium for Medicare Part B, which is typically deducted from your Social Security benefits. In some cases, for instance if you visit your doctor, there is a deductible and you pay some cost sharing.
So, what does Medicare Part B cover and not cover when it comes to your health?
What Medicare Part B covers
Certain medically necessary services like doctors’ visits and tests, outpatient care, home health services and durable medical equipment are covered by Medicare Part B.
Preventive services: This is care to prevent illness as well as to detect a condition or sickness at an early stage. Services include lab tests, surgeries, annual wellness exams, screenings and yearly flu shots. See a full list of covered preventive services at Medicare.gov.
Doctor/clinic care: If you’re sick or have a medical condition, Medicare Part B covers doctor’s visits and care. This includes any outpatient service you receive in your doctor’s office or in a clinic. Some inpatient services in a hospital are also covered.
Home health services: This is treatment provided in your home if you’re sick or injured and, when possible, helps patients regain independence and self-sufficiency. Coverage includes part-time skilled nursing care as well as physical and occupational therapy.
Medicare Part B also covers clinical trials; ambulance services; durable medical equipment such as wheelchairs, blood sugar test strips and crutches; mental health services; partial hospitalization; and some outpatient prescription drugs. It can also cover trips to the emergency room (ER) if you have an injury, a sudden illness, or an illness that quickly gets much worse. You may not be covered if you make an ER visit for a non-emergency.
What Medicare Part B does not cover
There are a number of services that Medicare Part B does NOT cover. This includes hospital expenses that are covered by Medicare Part A, as well as prescription drugs.
Cosmetic procedures and routine dental, vision, hearing and foot care are also not typically covered under Medicare Part B. This includes eye exams, hearing aids and dentures. Long-term care is also not covered.
Still wondering what Medicare Part B covers and does not cover? Talk to your doctor or health care provider so they can help you understand why you need certain tests, items or services, and if Medicare will cover them.