Medicare is a federal health insurance program for Americans who are at least 65 years old, disabled, or have end-stage renal disease (ESRD) or ALS (Lou Gehrig’s disease). It’s split into four parts; Part A, B, C, and D.
Part B is referred to as medical insurance, and it's the portion of Medicare that more closely resembles traditional health insurance. Let’s take a look at what Medicare Part B covers.
What Medicare Part B Covers
In short, Medicare Part B covers outpatient/medical services, some of which are subject to a deductible and a copay, but many are free. What does that mean, exactly? Here are the details.
Preventive health care services are typically free so long as you see a doctor or health care provider who accepts assignment (meaning they’ll accept the Medicare-approved amounts as full payment). These are services that help to prevent illness, keep you healthy, and detect conditions, including:
- 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
- A yearly “wellness” visit
For a complete list of the preventive services covered by Medicare Part B, refer to the Medicare and You handbook.
Other Medically Necessary Services
Additionally, Medicare Part B helps to cover other services or supplies that are necessary to treat or diagnose a medical condition. For example, services from doctors or healthcare providers, outpatient care, home health care, and durable medical equipment.
Here are some examples:
- 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
- Lab services, such as blood tests, urinalysis, and tests on tissue samples
This isn’t an exhaustive list—additional services may also be covered.
Unlike preventive services, these will often come with a deductible and a copay (20% of the Medicare-approved cost). Further, there's no yearly limit on how much you may have to pay out-of-pocket for health care services with Part B.
Many people also have a Medicare Supplement policy (Medigap) to provide more complete coverage and annual out-of-pocket cost limits.
What Isn't Covered by Medicare Part B
Medicare Part B doesn’t cover expenses that are covered by other parts of Medicare, such as inpatient care in hospitals, skilled nursing facility care, hospice care, and prescription drugs.
Further, there are a few notable types of care not covered. For example, most dental care, including dentures, is not covered under any portion of Medicare Parts A and B. Also, eye exams related to prescribing glasses (but not to an illness or issue), cosmetic surgery, hearing aids, fitting exams related to hearing aids, and concierge services aren’t covered under Medicare Parts A and B. You also won’t find long-term care as a covered service.
Also known as "custodial care," long-term care is non-medical care related to the six activities of daily living (bathing, dressing, eating, transferring, toileting, and continence).
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 the 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.
Medicaid (not Medicare) may cover long-term care costs if you're eligible and your nursing home or long-term care is deemed to be medically necessary.
Medicare Advantage (MA) Plans
Medicare Advantage (MA) Plans, also known as Medicare Part C, are health care plans from private companies that are approved by Medicare.
They include Medicare Part A and B, and typically also include Part D along with other benefits that Medicare plans lack. For example, it’s common for MA plans to include vision, hearing, and dental services. They may also offer lower out-of-pocket costs with a yearly out-of-pocket limit. However, they typically require you to use doctors in the plan’s network.
Once you qualify for Medicare, it’s a good idea to shop around. Compare the costs and benefits of Medicare Advantage plans alongside Original Medicare to find the best fit.
How To Enroll in Medicare Part B
Ready to enroll in Medicare Part B? Here are the steps to follow:
Check Your Eligibility
Before you enroll in any part of Medicare, you have to be eligible. You usually become eligible three months before you turn 65. However, you may also be eligible earlier if you are disabled or have ESRD or ALS. Additionally, you must be entitled to benefits based on your earnings, or the earnings of a child, spouse, or parent.
Those who have already been receiving Social Security or Railroad Retirement Board benefits (for at least four months) before turning 65 will automatically be enrolled in Part A and B when they turn 65.
Once you’re eligible for Medicare, you’ll have three options for applying (if you’re not automatically enrolled):
- You can apply to get Medicare coverage alone through the Social Security Administration (SSA).
- You can apply for Social Security benefits.
- You can apply for Railroad Retirement Board (RBB) benefits.
If you apply for Social Security or RBB benefits, you’ll also be applying for Medicare. Upon approval, you’ll automatically be enrolled in premium-free Part A coverage and can choose if you want Part B.
You can apply for Medicare or Medicare with Social Security benefits on the SSA’s website, by phone at 1-800-772-1213, or at your local Social Security office. On the other hand, you can apply for Medicare and RBB benefits by contacting the Railroad Retirement Board at 1-877-772-5772.
If you’re not entitled to premium-free Part A, it won’t be automatic. You’ll need to enroll with the SSA and pay for both Premium Part A and Part B during a valid enrollment period.
Enroll During an Enrollment Period
You can only enroll in Medicare Part B during an initial enrollment period, a general enrollment period, or a special enrollment period.
- Initial enrollment period (IEP): A seven-month period that starts three months before you turn 65 and ends three months after.
- General enrollment period: An annual enrollment period that runs from January 1 to March 31. Part B and Premium Part A coverage begin July 1 of that same year.
- Special enrollment period: An eight-month period that starts when employment or group health plan coverage ends.
If you don’t enroll in premium Part B when first eligible, you may have to pay a late enrollment penalty of up to 10% for each full 12 months in the period that you could’ve had Part B, but didn’t enroll for as long as you have Medicare Part B.
Frequently Asked Questions (FAQs)
How do you sign up for Medicare Part B?
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 will pay $499 per month in 2022. Those who worked at least 30 quarters are eligible for a reduced premium rate of $274 per month.
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 paid just $148.50 per month in 2021. This increased to $170.10 in 2022.