Medicare Part B

What is Medicare Part B

Medicare in general is a health insurance system established by the US Government. Its purpose is to aid US citizens in paying the costs of their healthcare.

Medicare is broken up into 4 categories:

    • Medicare Part A
    • Medicare Part B
    • Medicare Part C
    • Medicare Part D

Medicare Part A covers services that pertain to impatient hospital care while Medicare Part B covers services related to outpatient care. It consists of yearly deductibles as well as coinsurance.

What is covered under Medicare Part B

In general Medicare Part B covers medically necessary services and preventative services performed on an outpatient basis including the following: (these are a list of general services and is not an all inclusive list)

    • Doctors Services (primary and specialist)
    • Outpatient Care
    • Home Health Services
    • Durable Medical Equipment
    • Prosthetics
    • Ambulance Services
    • Ambulatory Surgical Centers
    • Blood
    • Rehabilitative Therapies (cardiac, occupational, speech, ect)
    • Chemotherapy
    • Diabetes Supplies
    • EKG
    • Emergency Room Services
    • Laboratory Services
    • Chiropractic

The following “Preventative Services are also included: (these are a list of general services and is not an all inclusive list)

    • Yearly “Wellness” visit
    • Abdominal aortic aneurysm screening
    • Alcohol misuse counseling
    • Bone mass measurement
    • Breast cancer screening (mammogram)
    • Cardiovascular disease (behavioral therapy)
    • Cardiovascular screenings
    • Cervical and vaginal cancer screening
    • Colorectal cancer screenings
    • Fecal occult blood test
    • Flexible sigmoidoscopy
    • Colonoscopy
    • Barium enema
    • Depression screening
    • Diabetes screenings
    • Diabetes self-management training
    • Flu shots
    • Glaucoma tests
    • Hepatitis B shots
    • HIV screening
    • Medical nutrition therapy services
    • Obesity screening and counseling
    • Pneumococcal shot
    • Prostate cancer screenings
    • Sexually transmitted infections screening and counseling
    • Tobacco use cessation counseling (counseling for people with no sign of tobacco related disease)

What is NOT covered under Medicare Part B

The following services are not generally covered under Medicare Part B: (these are a list of general services and is not an all inclusive list)

    • Custodial Care
    • Routine Dental
    • Routine Eye Care
    • Dentures
    • Cosmetic Surgery
    • Acupuncture
    • Hearing Aids

How do I qualify for Medicare Part B

There are several different ways you can qualify for Medicare Part B. The most common requirement is if you are a US citizen and you are 65 or older. However, being a US citizen age 65 or older is not the only way you can qualify to receive Medicare benefits. You may also qualify to receive Medicare benefits if you are under the age of 65 if you meet certain requirements. Certain disabilities, permanent kidney failure and other conditions can also make you eligible for Medicare benefits. You can always call your local Social Security administration if you need further assistance with Medicare eligibility.

How much does Medicare Part B cost

Unlike Medicare Part A, even if you have worked the appropriate number of quarters and meet all the other requirements to getting your Part A “free” there is a premium for Medicare Part B. Most people will pay a monthly premium of $144.60 for 2020. This number however is still based on income and as a result some individuals may pay more. The following is a breakdown of premiums and income and these numbers would be based on your tax return from 2 years ago:

Individual Tax Return Joint Tax Return YOU PAY:
$87,000 or less
$174,000 or less
$144.60 monthly
$87,000 up to $109,000
$174,000 up to $218,000
$202.40 monthly
$109,000 up to $136,000
$218,000 up to 272,000
$289.20 monthly
$136,000 up to $163,000
$272,00 up to $326,000
$376.00 monthly
$163,000 up to $500,000
$326,000 up to $750,000
$462.70 monthly
$500,000 and Above
$750,000 and Above
$491.60 monthly

What you can expect to pay for services under Medicare Part B

Under Original Medicare, there is a yearly Part B deductible of $196 for 2020. In most cases this Part B deductable has to be met or satisfied before Medicare begins to pay its share. After your deductible is met however, Medicare generally pays 80% of all Medicare Covered Service and you typically pay 20% of the Medicare-approved amount of the service. This rule of thumb applies only if the doctor or health care provider accepts the terms of the assignment. In the event that they are Medicare covered providers you would be responsible for the whole amount. In addition, there is no yearly limit for the out-of-pocket expenses you are responsible for under Original Medicare.

For most preventive services you pay nothing if you get the services from a doctor or other qualified health care provider who accepts assignment. However, there are some preventive services, you may have to pay a deductible, coinsurance, or both.

For more information on covered services and their related costs you can visit the Medicare website www.medicare.gov or refer to your Medicare and You Handbook.

Close Menu