Topics we will cover in this section:
Part B Services
Part B covers two types of Services:
Hospital care includes:
- Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.
- Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best.
Part B Coverage
Medical services and supplies covered by Medicare Part B include (but may not be limited to):
- Doctor visits
- Clinical research
- Laboratory tests and X-rays
- Emergency ambulance services
- Durable medical equipment (DME)
- Mental health services
- Inpatient (covered under Part A)
- Outpatient
- Partial hospitalization
- Preventive services, such as pap tests, flu shots, and screenings
- Getting a second opinion before surgery
- Rehabilitation services, including physical therapy, occupational therapy, and speech-language pathology services
- Limited outpatient prescription drugs
If you are unsure whether Medicare Part B covers a test, item, or service, talk with your doctor or search Medicare’s site.
Medicare Part B will NOT cover dentures, dental care, eye exams to prescribe glasses, or hearing-aid exams.
Preventive Services under Part B
Medicare covers many preventive testing services under Medicare Part B, in addition to a yearly appointment with your doctor to discuss your preventive care plan. Whether you have Original Medicare or Medicare Advantage, as long as you meet the eligibility, you can receive these services.
During your first yearly visit with your doctor, you should be ready to discuss things such as your medical and family history; list of medications, providers, and durable medical equipment (DME); and risk factors for chronic and mental health conditions.
Medicare Part B covers these preventive services:
- Abdominal aortic aneurysm screening
- Alcohol misuse screenings & counseling
- Bone mass measurements
- Cardiovascular disease screenings
- Cardiovascular disease
- Cervical & vaginal cancer screening
- Colorectal cancer screenings
- Depression screenings
- Diabetes screenings
- Diabetes self-management training
- Glaucoma tests
- Hepatitis C screening test
- HIV screening
- Lung cancer screening
- Mammograms
- Nutrition therapy services
- Obesity screenings & counseling
- One-time “Welcome to Medicare” preventive visit
- Prostate cancer screenings
- Sexually transmitted infections screening & counseling
- Flu shots
- Hepatitis B shots
- Pneumococcal shots
- Tobacco use cessation counseling
- Yearly “Wellness” visit
Durable Medical Equipment (DME)
- Medicare Part B covers medically necessary DME, which includes prosthetics, orthotics, power mobility devices, and other supplies such as home oxygen equipment and hospital beds.
- Various prescription drugs or supplies (such as medications used with nebulizers or test strips for diabetes) are considered DME and are covered under Medicare Part B.
DME Under Medicare Part B
In order for Medicare Part B to cover DME, criteria require that the equipment be: durable, used for medical reasons, not useful to someone who isn’t sick or injured, used in your home, and expected to last at least three years. The DME that Medicare covers is not limited to, but includes:
- Air-fluidized beds and other support surfaces (these supplies are only rented)
- Blood sugar monitors
- Blood sugar test strips
- Canes
- Commode chairs
- Continuous passive motion (CPM) machine
- Crutches
- Hospital beds
- Infusion pumps and supplies
- Manual wheelchairs and power mobility devices
- Nebulizers and nebulizer medications
- Oxygen equipment and accessories
- Patient lifts
- Sleep apnea and Continuous Positive Airway Pressure (CPAP) devices and accessories
- Suction pumps
- Traction equipment
- Walkers
Mental Health Coverage under Medicare Part B
Medicare Part B covers mental health services and visits for outpatients with professionals such as psychiatrists, clinical social workers, clinical psychologists, clinical nurse specialists, nurse practitioners, and physician assistants. It also covers outpatient mental health services under circumstances like a healthcare provider’s office, hospital outpatient, or a community mental health center.
Along with these services, Part B covers:
- One depression screening per year when done in a primary care doctor’s office or clinic
- Individual and group psychotherapy with doctors or licensed professionals allowed by the state
- Family counseling
- Medication management
- Testing to see if you’re getting the services you need
- Certain prescription drugs
- Diagnostic tests
- Psychiatric evaluation
- Partial hospitalization
- Yearly “wellness” visit and a one-time preventive visit.
