What Medicare Part B Covers

When you turn 65 years old, or if special circumstances apply, you are eligible to apply for Medicare coverage.
Along with Medicare Part A, Part B is one of the most important parts of original Medicare. Because Part A and Part B cover different things, most people who opt for original Medicare choose both. As Medicare health insurance brokers in Santa Rosa, we can help you understand your sometimes-complicated options. Here is what you need to know about Medicare Part B. 



What Does Medicare Part B Cover?

While Medicare Part A covers inpatient hospital care, Part B covers just about everything else involved in health care, except for prescription medications. The Centers for Medicare and Medicaid Services divide covered services into two different categories: preventive services and medically necessary outpatient services. 

Preventive services include those intended to prevent you from getting a disease, such as some vaccines. For example, the pneumonia shot and flu shot are covered by Part B, while the shingles vaccine is covered by Part D prescription coverage. Some vaccines are only covered under certain circumstances. If you are at medium to high risk for hepatitis B, Medicare Part B will cover the vaccine whereas it wouldn’t be covered otherwise. 

Preventive services also include screenings intended to catch diseases, such as diabetes, cancer, heart disease, hepatitis C, and glaucoma, in their early stages. Early diagnosis provides the best prognosis for successful treatment or management. Examples of screenings included under Medicare Part B as preventive services include the following: 

Blood testsPap smearsMammogramsColonoscopies

Part B also covers outpatient services that are medically necessary, such as doctor’s visits for checkups, injuries, or illnesses. X-rays are covered under Medicare Part B. Even though emergency room visits take place in a hospital, they are covered under Part B. However, if you were to be admitted to the hospital following your emergency room visit, that would be covered under Part A. 

By definition, home health services are provided on an outpatient basis. Therefore, Medicare Part B may cover some home health services, but only those deemed medically necessary. 

This is a broad overview of what Medicare Part B covers. There are numerous exceptions that apply, mostly hinging on whether the service is deemed medically necessary or not. The companies in each state that process claims for Medicare make coverage decisions at the local level under applicable state laws, while CMS makes national coverage decisions according to federal law. 

Furthermore, Part B only covers 80% of the costs of medically necessary services. You typically have to pay the remaining 20% out of your own pocket. However, depending on the provider you choose, you may be able to receive preventive services at no cost under Medicare Part B. 

How Much Does Medicare Part B Cost?

Another respect in which Medicare Part B differs from Part A is that, while Part A is available to most people at no cost, depending on work history, Part B charges a monthly premium. The CMS sets the monthly premium, which may undergo changes from year to year. In 2022, the monthly premium for most people is $170.10. If you receive federal retirement benefits, Railroad Retirement Board benefits, or Social Security, the premium amount may be automatically deducted from your monthly check. 

Not everyone who enrolls in Medicare is retired. Some people continue working even after enrolling in Medicare. These people may have a higher-than-average income. Individuals who make more than $91,000 per year or married couples with an annual income in excess of $182,000 may have to pay more for Medicare premiums. 

In addition to the monthly premium, there is also an annual deductible that applies to services covered under Medicare Part B that you have to pay out of pocket. In other words, the first $233 in medical expenses that you incur are your responsibility. Once that benchmark is met, Part B covers 80% of expenses for all other medically necessary expenses.

Who Is Eligible for Medicare Part B?

Medicare Part B is available to U.S. citizens who are over the age of 65. Lawfully permanent residents are also eligible as long as they have reached the necessary age requirement and have dwelt continuously in the United States for at least five years. 

There are circumstances in which people younger than 65 can qualify for Medicare Part B. You can qualify for Part B regardless of age if you have certain terminal diagnoses, such as amyotrophic lateral sclerosis, also known as ALS or Lou Gehrig’s disease, or end-stage renal disease. People who have received Railroad Retirement Board disability or Social Security Disability benefits for at least 24 months, or two years, are also eligible to enroll in Medicare Part B even if under age 65. 

Make Sense of Your Medicare Options

With all the different exceptions and contingencies, making sense of your Medicare options can be a challenge. At Sackett & Associates, we have Medicare health insurance brokers who can explain your options to you and
make recommendations based on your individual needs. Contact us for more information on how to get started.