What Does Medicare Part B Cover?
Medicare Part B Is Not Free, and Doesn't Cover Everything
Medicare forms the foundation of health care coverage for Americans age 65 and older. Medicare does not work the same ways as a traditional health insurance plan while you are working, it is not free, and it will not cover all your health care expenses. Here’s how it works.
A portion of Medicare coverage, Part A, is free for most Americans who worked in the U.S. and thus paid payroll taxes for many years.
Part A is called “hospital insurance.” If you qualify for Social Security, you will qualify for Part A.
Part B, referred to as medical insurance, is not free. You pay a monthly premium for Medicare Part B. Part B is the portion of Medicare that more closely resembles what you may think of as traditional health insurance. Let’s take a look at what Medicare Part B covers.
What Medicare Part B Covers
Check out the Medicare and You handbook and you’ll find about 25 pages describing the covered services available under Medicare Part B. Many of the covered services are subject to a deductible and co-pay.
In general, Medicare Part B covers medically necessary services and supplies needed to diagnose and treat a medical condition. Medicare Part B also covers certain types of preventative care. Let’s start by looking at some of the preventative services covered.
You usually will not pay extra for preventative services.
Below is a sample of the preventive services covered by Medicare Part B. Additional services not listed here may also be available.
Some of the preventative services covered are: alcohol misuse screenings, bone density measurements, cardiovascular disease screenings, mammograms, cancer screenings (such as for cervical, colorectal, prostate, etc.) diabetes screenings, depression screenings, diabetes screenings, flu shots, glaucoma tests (if you are considered to be at high risk for this disease), pneumococcal shot, and a yearly “wellness” visit.
Other Medically Necessary Services
There are other items covered by Part B in addition to preventive services. For many of these items, a deductible may apply, and you may pay 20 percent of the Medicare-approved cost. For this reason, many people also have a Medicare Supplement policy, sometimes called a Medigap policy, to help cover the “gaps” in coverage.
Here are some other items covered by Part B which may be subject to the deductible and co-pay: ambulance services, cardiac rehabilitation, a portion of outpatient chemotherapy, implanted defibrillator, diabetes supplies, durable medical equipment (like oxygen equipment, wheelchairs, walkers), certain types of medically necessary home health services, kidney dialysis and supplies, physical therapy, second surgical opinions, tests such as MRIs, CT scans, EKG/ECGs, and a CPAP trial (for up to three months) if you have been diagnosed with obstructive sleep apnea.
Note: additional services not listed may also be covered.
Medicare Part B also covers most lab services such as blood tests, urinalysis, and tests on tissue samples. Usually, you will not pay extra for these lab services.
What Isn't Covered By Medicare Part B
Most dental care, including dentures, is not covered under any portion of Medicare.
Eye examinations related to prescribing glasses (vs. related to an illness or issue), cosmetic surgery, acupuncture, hearing aids, fitting exams related to hearing aids, and concierge services are not covered by Medicare Part B or by any other part of Medicare.
Also, many people are not aware that Medicare will not cover long-term care. Long-term care is non-medical care related to the six activities of daily living. For example, many people need help later in life with activities like bathing, dressing, preparing meals, and using the restroom. This type of care is not covered under Medicare.
Medicare Part A does cover a portion of costs for skilled nursing home care, but only after a 3-day minimum inpatient hospital stay. Many people need skilled nursing home care due to a disability or disease but don’t meet the minimum hospital stay requirement.
This means you cannot count on Medicare Part A or Part B to cover nursing home or long-term care expenses.
However, if your income and assets are low enough, you may become eligible for Medicaid. If you are eligible for Medicaid and your nursing home or long-term care is deemed medically necessary, then Medicaid (not Medicare) may cover the cost.