Medicare Part B – Medical Insurance

Last Updated : 06/20/20194 min read

Medicare Part B is medical insurance. Along with Medicare Part A (hospital insurance), it makes up Original Medicare, the federal health insurance program.

Here’s something important to know about Medicare Part B: you need this coverage if you decide to sign up for a Medicare Advantage plan, or buy a Medicare Supplement insurance plan.

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What does Medicare Part B cover?

As long as you meet certain requirements, Part B may cover many health-care services and supplies. Here’s a partial list (a complete list would go on for several pages). Please note that your care must come from providers who accept Medicare assignment.

  • Doctor visits
  • Certain cancer screenings
  • Certain lab tests
  • An annual wellness visit with your primary care provider
  • A one-time Welcome to Medicare visit with your primary care provider
  • Diabetes screening, supplies, and certain services
  • A diabetes prevention program for those who qualify
  • Alcohol abuse screening and counseling for those who qualify
  • Flu shots
  • Pneumonia shots
  • Depression screenings
  • Second opinions when your doctor decides you need surgery

How much does Medicare Part B coverage cost?

Medicare Part B generally pays 80% of approved costs of covered services, and you pay the other 20%. Some services, like flu shots, may cost you nothing.

Most people pay a monthly premium for Medicare Part B. The standard premium is $135.50 in 2019. You could pay more than that if your income is higher than a certain amount, and less if you qualify for state-based help if your income is lower than a certain amount.

A Part B deductible applies to some covered services. The annual Part B deductible is $185 in 2019.

After you pay your deductible, you generally pay a 20% coinsurance (as mentioned above) for most covered services.

What doesn’t Medicare Part B cover?

Medicare Part B doesn’t cover every possible medical expense. Here’s a partial list of what Part B doesn’t generally cover.

  • Hospital inpatient care, such as a semi-private room, meals, and more. These are usually covered under Medicare Part A. Doctor visits in the hospital may still be covered under Part B.
  • Some tests and services that your doctor might order or recommend for you. If your doctor wants you to have lab tests, or any services beyond your standard annual wellness visit, you might want to ask whether Medicare covers them. Medicare Part B might cover some of these services.
  • Routine dental care
  • Routine vision care
  • Most prescription drugs you take at home. Medicare Part B may cover certain medications administered to you in an outpatient setting.
  • Hearing aids
  • 24-hour home health care
  • Long-term care, such as you might get in a nursing home. If the only care you need is custodial, meaning help with tasks such as bathing and dressing, Medicare doesn’t generally cover it.

Some of these services, such as routine dental and vision care, might be covered under a Medicare Advantage plan.

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Do I have to enroll in Medicare Part B?

What if you have other medical coverage, like an employer’s plan? Do you still have to sign up for Part B?

You can choose to delay Part B enrollment, as some people do when they’re covered under an employer’s or union-based health insurance plan. However, when that coverage ends, be aware that if you don’t sign up for Medicare Part B within a certain period of time, you might face a Part B late enrollment penalty.

Here’s one reason you might want to sign up for Medicare Part B. Suppose you decide you’d like to buy a Medicare Supplement insurance plan. Or, you want to enroll in a Medicare Advantage plan. Both of these types of coverage require you to be enrolled in both Medicare Part A and Part B.

If you stay with Original Medicare and decide to sign up for a stand-alone Medicare Part D prescription drug plan, you need to be enrolled in Medicare Part A and/or Part B.

Please note that even if you decide to get your Original Medicare benefits through a Medicare Advantage plan, you still have to pay our monthly Medicare Part B premium. Of course, if the Medicare Advantage plan charges a premium, you’ll need to pay that as well. Some Medicare Advantage premiums are as low as $0.

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The product and service descriptions, if any, provided on these Medicare.com Web pages are not intended to constitute offers to sell or solicitations in connection with any product or service. All products are not available in all areas and are subject to applicable laws, rules and regulations.

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