Medicare Part B helps cover medically-necessary services like doctors’ services and tests, outpatient care, home health services, durable medical equipment, and other medical services. Part B also covers some preventive services. Look at your Medicare card to find out if you have Part B. The basic
medically-necessary services covered include: To find out if Medicare covers a service not on this list, visit www.medicare.gov/coverage, or call 1-800-MEDICARE (1-800-633-4227). TTY users
should call 1-877-486-2048.
Content created by Digital Communications Division (DCD)
Content last reviewed September 11, 2014
Medicare Part B helps cover medical services like doctors' services, outpatient care, and other medical services that Part A doesn't cover. Part B is optional. Part B helps pay for covered medical services and items when they are medically necessary. Part B also covers some preventive services like exams, lab tests, and
screening shots to help prevent, find, or manage a medical problem. Cost: If you have Part B, you pay a Part B premium each month. Most people will pay the standard premium amount. Social Security will contact some people who have to pay more depending on their income. If you don't sign
up for Part B when you are first eligible, you may have to pay a late enrollment penalty. For more information about enrolling in Medicare, look in your copy of the "Medicare & You" handbook, call Social Security at 1-800-772-1213, or visit your local Social Security office. If you get benefits from the Railroad Retirement Board (RRB), call your local RRB office or 1-800-808-0772. Learn More:
- Should I get Medicare Part B?
Content created by Digital Communications Division (DCD)
Content last reviewed September 16, 2014
Summary:
Think of Part B as insurance for your everyday care. From doctor visits and screenings to medical equipment and home health support, Part B has you covered.
Getting ready to choose a Medicare plan? No matter which one you select — whether that’s Original Medicare or one of the many Medicare Advantage plans — all of them offer Part B coverage.
Part B is the workhorse of your medical insurance. It covers:
- Services from doctors and other providers
- Certain medical equipment
- Outpatient care (including urgent care)
- Home health care
- Preventive services, including screenings and vaccines
Unlike Original Medicare’s Part A (hospital insurance) — which is free for most Americans — you’ll have to pay a monthly premium for Part B. It’s $170.10 in 2022. “But since you pay a premium for Part B,” says Caitlin Donovan, a spokesperson for the Patient Advocacy Foundation, “you can opt out of it [or delay your enrollment until a later date],” like when you stop working or lose coverage from your employer.
Here’s what else you should know about Medicare Part B.
Finding the Medicare plan that’s right for your life and budget doesn’t have to be overwhelming — eHealth is here to help. Get started now.
What is covered under Medicare Part B?
Medicare Part B covers most of your routine, everyday care. Part A, on the other hand, covers only care and services you receive during an actual hospital stay. If you happen to use the hospital for your lab work or imaging, those fall under Part B.
We outlined some of the services that are covered under Part B above, and here are a few specifics:
- Ambulance services, such as ground transportation to a hospital
- Durable medical equipment, including wheelchairs, walkers, and hospital beds
- Heart disease screenings
- Cardiac rehabilitation, including exercise, education, and counseling
- Cancer screenings, including those for cervical, vaginal, lung, breast, prostate, and colorectal cancer
- Chemotherapy if you have cancer
- Diabetes care, including equipment and supplies (such as test strips and lancets)
- Some acupuncture and chiropractic services
- Physical therapy
- Screenings for depression, diabetes, hepatitis C, and HIV
- Tests, including X-rays, MRIs, CT scans, and EKGs/ECGs
- Flu shots and other vaccines
- Diabetes-related foot care
- Smoking cessation services
During the first 12 months that you’re enrolled in Part B, you can also get a “Welcome to Medicare” preventive visit. You’ll meet with your doctor to review your medical history and learn more about the preventive services that are right for you.
Ready to start exploring Medicare Advantage plans? Start here.
What’s not covered under Medicare Part B?
Original Medicare doesn’t cover every medical service. Part A and Part B usually don’t cover:
- Long-term care (such as at a nursing home)
- Most dental care
- Eye exams for eyeglasses
- Dentures
- Cosmetic surgery
- Hearing aids (and exams for fitting them)
- Routine foot care (such as trimming, cutting, or clipping nails)
- Most prescription medications
- Care outside the U.S.
Medicare Supplement plans, such as Part D for medication coverage, can help fill in the gaps (they’re called Medigap for a reason). You can often get additional benefits through a Medicare Advantage plan as well. Known as Part C, these Medicare-approved plans are offered by private insurance companies. They’re a kind of “hybrid” between government insurance and private insurance, says Donovan.
By law, Medicare Advantage plans must offer at least the same level of coverage as Original Medicare. And some plans provide additional coverage not included in Original Medicare such as routine dental and/or vision, hearing, and even prescription medication coverage.
Am I eligible for Medicare Part B?
“Medicare isn’t just available for everyone,” says Donovan. Specifically, you’re eligible for Medicare Part B if:
- You’re 65 or older
- You have certain disabilities (if you’re younger than 65)
- You have end-stage renal disease (if you’re younger than 65)
If you’re eligible to receive Social Security Disability Insurance (SSDI) benefits, you’ll be eligible to join Medicare after a 24-month waiting period, and you’ll be enrolled automatically.
If you have amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease, you’ll be automatically signed up for Medicare when your Social Security disability benefits start.
When can I enroll in Medicare Part B?
Some people will be enrolled automatically, but others will have to sign up on their own. You will be enrolled automatically in Part A and Part B if:
- You’re already receiving benefits from Social Security or the Railroad Retirement Board (RRB)
- You have a disability and receive Social Security disability benefits. (You’ll have to wait 24 months before you’re eligible, however, says Donovan. In this case, your Medicare coverage will start in Month 25.)
- You have Lou Gehrig’s disease
If you’re not automatically enrolled, you’ll need to sign up during one of these three enrollment periods:
- Initial Enrollment Period, the seven-month period that begins three months before you turn 65 and ends three months after you turn 65.
- Special Enrollment Period, which occurs when your coverage from an employer ends.
- General Enrollment Period, which takes place from January 1 to March 31 of each year.
Can I delay enrolling in Medicare Part B?
Since you have to pay a premium for Medicare Part B, you can delay your coverage. “Some people opt out of Part B if they’re still working and have coverage through an employer [or a spouse’s employer],” says Donovan.
If you decide to keep your current health insurance, you can sign up for Part B up to eight months after your coverage or employment ends (whichever one ends first) without incurring a late enrollment penalty. This is called your Special Enrollment Period.
Miss this window and your monthly Part B premium may go up 10% for each 12-month period that you could’ve had Part B but didn’t. For example, if you put off signing up for Medicare for two years, you’ll pay a 20% premium penalty for as long as you have Part B, says Donovan.
You may also have to pay this extra fee if you miss your initial enrollment period and don’t have an employer-sponsored plan at the time.
How much does Medicare Part B cost?
Unlike Part A, which is free for most Americans, Part B comes with a cost. The standard monthly premium for Medicare Part B is $164.90 for 2023, though this amount can change from year to year. (If your income is over a certain amount, you might have to pay higher rates — see the chart below.)
If you collect Social Security or Railroad Retirement Board benefits, your Medicare Part B premium can be automatically deducted from these benefits. If you don’t collect these benefits, you’ll get a bill for Part B every three months.
Who pays higher Part B premiums because of income?
If you (or you and your spouse, if you file jointly) have a higher income, you’ll pay a higher premium. Here’s the breakdown, according to 2022 yearly income:
If you’re married and filing separately, you’ll pay $544.30 if your income is above $91,000 but less than $409,000. If your yearly income was $409,000 or more, you’ll pay $578.30.
What is the Medicare Part B deductible?
The annual deductible for Medicare Part B in 2023 is $164.90. You usually need to pay this amount before Medicare starts paying its share for covered services.
What are the coinsurance and copayments for Medicare Part B?
With Medicare Part B, you usually have to pay a 20% coinsurance — meaning a percentage of the cost. For example, if a service costs $100, you would pay $20, while Medicare would pay $80.
Here’s the catch, though: Medicare will only pay a certain price for a doctor’s visit or health service. If your provider accepts that amount — i.e., the “Medicare-approved amount” — then the fee will be covered. If your doctor doesn’t accept Medicare, in some instances you may have to pay the full price for the service.
Also important to know: Original Medicare has no yearly limit on how much you have to pay for out-of-pocket services. You could be on the hook for thousands if you have a long hospital stay or recovery and don’t have supplemental insurance to help offset the costs.
Medicare Advantage plans, however, do have an out-of-pocket maximum. Once you spend that amount, the rest of your care for the plan year is covered at 100%.
Ready to get started? Find a plan that fits your budget and covers your doctor and prescription medications now.