Medicare Part B: What Does it Cover?

If you've spent any time researching Medicare, you've probably seen phrases like "Part A" and "Part B." While Medicare Part A covers inpatient hospital coverage, Medicare Part B is what covers the care that people receive in the doctor's office. But there's a lot more to it than that. In this article, we'll be sharing what you need to know about Medicare Part B and everything from premiums, deductibles and the benefits included.

What is Medicare Part B?

How It Fits Into Original Medicare

Medicare Part B is the second portion of the Federal program known as Original Medicare. Medicare Part B provides coverage for certain medical services that are not covered by Medicare Part A, like doctor visits, lab tests and more.

Who’s Eligible for Part B?

Most people become eligible for Medicare Part B when they turn 65, but individuals under 65 with certain disabilities or medical conditions may also qualify. To qualify, you must be a U.S. citizen or a legal resident who has lived in the U.S. for at least five continuous years.

Why Medicare Education Matters for Making Informed Choices

What You’ll Pay for Medicare Part B

Medicare Part B has a monthly premium that varies based on income, with standard amounts set each year. You’ll also pay an annual deductible, and after that, you're responsible for 20% of the cost for covered services with no cap on out-of-pocket expenses.

How to Enroll in Medicare Part B

The process for enrolling in Medicare Part B will depend on several factors, including your age, reasons for eligibility, and if you are enrolling in Medicare Part A at the same time or if you are already enrolled in Medicare Part A.

Learn more about when and how to enroll in Medicare by attending one of our free Medicare 101 workshops or webinars.

What Does Medicare Part B Cover?

Medically Necessary Services

Medicare Part B covers medically necessary services received in the clinic (note that clinics and providers seen must accept Medicare assignment). Medicare Part B also covers procedures and surgeries such as:

• Lab tests
• Diagnostic testing
• Radiology, MRI, CT Scans, and X Rays 
• Emergency ambulance

Durable Medical Equipment (DME)

Medicare Part B covers durable medical equipment (DME) such as wheelchairs, walkers, crutches, insulin pumps, and hospital beds.

Preventive Services and Screenings

Certain preventive/screening services are covered by Medicare Part B. For most of these preventative or screening services, you pay nothing if you get the services from a healthcare provider who accepts Medicare.

Part B Medications

Covered Part B Medications include chemotherapy, infusions, injections (such as osteoporosis injections), infused drugs, antigens, and insulin (that is used with an insulin pump). Keep in mind that the injections are done in a medical facility.

Preventive Vaccines

Medicare Part B covers certain preventive vaccinations such as flu, pneumonia and Covid-19.

Understanding Medicare Vaccine Coverage: What’s Included, from Flu to RSV

What Services are Not Covered by Medicare Part B?

Routine Dental, Vision, and Hearing Care

Original Medicare Part B does not cover most dental care, dentures, eye exams related to prescribing glasses, hearing aids or exams for fittings. However, other types of Medicare plans, such as Medicare Advantage plans, may have coverage for these services.

Long-Term Care

Medicare Part B does not cover long-term care (also called custodial care). Find out more about long-term care coverage options.

Most Prescription Drugs

Medicare Part B does not cover most prescription drugs that you pick up at the pharmacy; however, there are some exceptions. For coverage for prescription medications (and to avoid penalties), you would need to enroll in a Medicare Part D plan or a Medicare Advantage plan with Part D coverage.

Learn More About Part B vs. Part D Medicare Drug Coverage

Other Services Not Covered By Part B

Additional services that wouldn't be covered by Medicare Part B include:

• Cosmetic surgery
• Routine foot care
• Routine physicals

If you need any of these services, you have to pay 100% of the cost. If you have other insurance coverage, this additional insurance may cover some of these costs.

When it comes to Original Medicare, Part B plays a key role in covering everyday medical care like doctor visits and preventive services, but it doesn't cover everything. Understanding your coverage and where there may be gaps can help you make informed choices about your Medicare insurance. If you have questions or would like to explore additional coverage options to better protect your health and budget, we're here to help you find a plan that fits your needs.

This is an updated blog that was originally published in 2019. 

Choosing a Medicare plan can be difficult. Twin City Underwriters helps Medicare recipients in Minnesota, Wisconsin, North Dakota, South Dakota, Iowa and Florida find the Medicare plan that meets their unique needs. Schedule a one-on-one meeting with one of our Medicare insurance brokers to get your questions answered!

Do you need help with Medicare, insurance and health plans? Explore your options with Allina Health Aetna, BlueCross BlueShield of Minnesota, Medica, UCare, United HealthCare and more. We work with you to find the best plan for your needs and budget. Contact us today to get started.