This article was originally published on June 20, 2016, and updated on June 26, 2017.
What is Medicare Part B coverage?
Medicare Part B helps cover medically necessary services and supplies needed for the diagnosis or treatment of your health condition. This includes outpatient services received at a hospital, doctor’s office, clinic, or other health facility. Medicare Part B also helps cover many preventive services to thwart illnesses or detect them at an early stage.
Medicare Part B benefits
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
- Mental health services
- Durable medical equipment (DME)
- Preventive services, such as pap tests, flu shots, and screenings
- Getting a second opinion before surgery
- Rehabilitative services, including physical therapy, occupational therapy, and speech-language pathology services
If in doubt, check to find out if Medicare covers a service or item.
Medicare Part B costs
Medicare Part B involves some costs. You’ll pay both a monthly premium and a yearly deductible for Medicare Part B. The monthly premium amount may vary depending on your specific situation:
- You’ll generally pay $109.00 for your monthly premium if you were enrolled in Part B before 2017.
- If any of the following applies to you, you’ll generally pay $134.00 for your Part B premium:
- You enroll in Part B for the first time in 2017.
- You aren’t receiving Social Security or Railroad Retirement Board benefits.
- You’re billed directly for your Part B premium.
- You have both Medicare and Medicaid coverage, and Medicaid pays for your monthly premiums.
You may have to pay a higher premium if your yearly income is above a certain amount, as reported on your tax return from two years ago. In addition, if you didn’t enroll in Medicare Part B when you were first eligible, you may have to pay a late-enrollment penalty in the form of a higher premium, unless you’re eligible for a Special Enrollment Period.
In addition to your monthly premium, you’ll pay $183.00 for the yearly Part B deductible.
For individual services and supplies, your Medicare Part B costs may vary. Some preventive services are completely covered if your provider accepts Medicare assignment. If the Medicare Part B deductible applies, you must pay all costs until you meet the yearly deductible amount before Medicare begins paying its share.
After your deductible is met, you typically pay 20% of the Medicare-approved amount for the service. You may also owe a copayment for certain outpatient services.