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Medicare Part B - Medicare Medical Coverage

What is Medicare Part B?

Medicare Part B is the category of Medicare medical insurance coverage that includes various outpatient medical services, doctor services, other home health services. Part B is a voluntary program and Medicare-eligible individuals must enroll to receive the program's benefits. To be eligible for Medicare Part B, one must be a U.S. citizen over the age of 65 or younger with a qualifying disability. Most beneficiaries are automatically enrolled in Part B and will receive their Medicare card in the mail three months before their 65th birthday. Those who are not automatically enrolled must fill out an application for Part B coverage.

Medicare Part B covered services are reimbursed at 80% of the "reasonable charge" for the service. The person receiving the service is responsible for paying the remaining 20%. However, this reasonable charge is determined by Medicare and may not adequately reflect the costs you pay to your physician. When a doctor agrees to accept the Medicare set "reasonable charge" as full payment, he or she is said to accept "assignment." When a doctor does not accept "assignment" the patient is responsible for paying the outstanding balance minus the Medicare-determined reimbursement. However, federal law sets a limit as to the maximum amount a doctor may bill for a service. The maximum amount to be billed for a Medicare Part B covered service is 115% of the Medicare "reasonable charge." If the doctor bills above this cap, he or she violates federal law.

What does Medicare Part B Cover?

The Medicare medical coverage provided by Part B is expansive. Some of the important medical services covered are:

  • "Welcome to Medicare" physical exam and yearly wellness exams
  • Diagnostic tests/lab work/screenings
  • Doctor services
  • Ambulance services
  • Nursing services
  • Chemotherapy
  • Certain diabetic supplies
  • Flu and pneumonia vaccinations
  • Durable medical equipment (e.g. wheelchairs, walkers, etc.)
  • Some mammography and pap smear screening

Medicare Part B does not cover various items including:

  • Prescription drugs (that are not administered to you by a physician)
  • Routine physical check-ups aside from yearly wellness exams
  • Alternative care such as chiropractic
  • Vaccinations or immunizations other than the flu and pneumonia shots
  • Eye examinations and eye glasses
  • Hearing aids

Medicare Part B Costs

The monthly premium for Medicare Part B can change annually and it is common for enrollees to have their Part B premium deducted from their Social Security check.

In 2016, most people will continue to pay $104.90 for their monthly Medicare Part B premium. However, some people are required to pay higher premiums. For example, people who enrolled in Part B for the first time on January 1, 2016 or later will pay $104.90. Additionally, individuals with income above $85,000 and couples with income above $170,000 will pay even higher premiums.

Additionally, beneficiaries must pay a yearly deductible before Medicare begins paying its share. In 2016, this deductible is $147. Once this is covered, beneficiaries only pay 20% of the Medicare-approved amount ("reasonable charge") while Medicare covers the remaining 80%.

Medicare Advantage Plans, sometimes called "Part C" or "MA Plans," are offered by private companies approved by Medicare and provide Medicare Part A and Part B coverage. Medicare prescription drug coverage is insurance run by an insurance company or other private company approved by Medicare. A Medicare Supplement plan is a health insurance plan provided by a private company that fills in the "gaps" in original Medicare coverage.

Medicare has neither reviewed nor endorsed this information.

To learn about Medicare plans you may be eligible for, you can:

  • Contact the Medicare plan directly.
    • Call 1-800-MEDICARE (1-800-633-4227), TTY users 1-877-486-2048; 24 hours a day, 7 days a week.
  • Contact a licensed insurance agency such as PlanPrescriber's parent company, eHealth.
    • Call eHealth's licensed insurance agents at , TTY users 711. We are available . You may receive a messaging service on weekends and holidays from February 15 through September 30. Please leave a message and your call will be returned the next business day.
    • Or enter your zip code where requested on this page to see quote.
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