Medicare is the foundation of health care coverage for Americans age 65 and older. A portion of Medicare coverage, Part A, is free for most Americans who worked in the U.S. and paid in payroll taxes for many years. Part A is called “hospital insurance.” You'll qualify for Part A if you qualify for Social Security.
Part B is referred to as medical insurance, and it's not free. You'll pay a monthly premium for Medicare Part B. It's the portion of Medicare that more closely resembles traditional health insurance. Let’s take a look at what Medicare Part B covers.
You'll usually pay nothing for preventive services, as long as the health care provider accepts assignment. Some covered preventive services include:
- Alcohol misuse screenings
- Bone density measurements
- Cardiovascular disease screenings
- Cancer screenings (such as for cervical, colorectal, or prostate)
- Depression screenings
- Diabetes screenings
- Flu shots
- Glaucoma tests if you're considered to be at high risk for this disease
- Pneumococcal shot
- A yearly “wellness” visit
This is not a complete list of preventive services covered by Medicare Part B. Additional services not listed are also available.
Other Medically Necessary Services
Many other items are covered by Part B in addition to preventive services. A deductible may apply to several of them, and you may have to pay 20% of the Medicare-approved cost. There's no yearly limit on how much you may have to pay in out-of-pocket costs for health care services.
Many people also have a Medicare Supplement policy for this reason, sometimes called a Medigap policy because it helps cover the “gaps” in coverage. These supplemental policies may provide more complete coverage with the assurance of annual out-of-pocket cost limits.
Some items covered by Part B which may be subject to the deductible and copay include:
- Ambulance services
- Cardiac rehabilitation
- A portion of outpatient chemotherapy
- Implanted defibrillator
- Diabetes supplies
- Durable medical equipment like oxygen equipment, wheelchairs, and 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've been diagnosed with obstructive sleep apnea
Medicare Part B also covers most lab services, such as blood tests, urinalysis, and tests on tissue samples. You usually won't have to pay extra for these lab services. Additional services not listed here may also be covered.
What Isn't Covered by Medicare Part B
Most dental care is not covered under any portion of Medicare Parts A and B, including dentures. Eye examinations related to prescribing glasses (but not to an illness or issue), cosmetic surgery, hearing aids, fitting exams related to hearing aids, and concierge services are not covered by Medicare Parts A and B, either.
Medicare will not cover long-term care. Also known as "custodial care," long-term care is non-medical care related to the six activities of daily living. 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.
This lack of coverage isn't unique to Medicare Parts A and B. Most health insurance plans, including Medigap coverage, don't cover these services, according to the Centers for Medicare & Medicaid Services.
Medicare Part A does cover a portion of costs for skilled nursing home care, but only as an inpatient and not on a long-term basis. Many people need skilled nursing home care due to a disability or disease, but they don’t meet the minimum hospital stay requirement. You can't count on Medicare Part A or Part B to cover nursing home or long-term care expenses if this describes your situation.
You may become eligible for Medicaid if your income and assets are low enough, however. Medicaid (not Medicare) may cover the cost if you're eligible for Medicaid and your nursing home or long-term care is deemed to be medically necessary.
Frequently Asked Questions (FAQs)
How do you sign up for Medicare Part B?
You can sign up for Medicare Part B by visiting the Social Security website. You can also call Social Security at 1-800-772-1213 (1-800-325-0778 for TTY users), mail in a form, or visit your local Social Security office.
How much does Medicare Part A cost?
Medicare Part A is free for those who have paid Medicare taxes for at least 40 quarters. You can buy Medicare Part A if you didn't work enough quarters. The amount you'll pay is based on the number of quarters you worked. Those who worked less than 30 quarters paid $471 per month in 2021. This increases to $499 in 2022. Those who worked 30 to 39 quarters paid $259 in 2021, increasing to $274 in 2022.
How much does Medicare Part B cost?
Medicare Part B total monthly premium amounts range from $170.10 to $578.30 in 2022, depending on your income and filing status. Most people pay just $148.50 per month in 2021, increasing to $170.10 in 2022, because they've paid in through deductions from their paychecks through their working lives.