From treatment for a common cold or a minor injury to help with managing chronic health issues, Medicare Part B offers coverage for doctor visits and outpatient care.
What does Original Medicare Part B cover?
While Original Medicare Part A, with its coverage for hospital visits and skilled nursing care, can help you manage the “big stuff,” that’s only part of the picture. Original Medicare Part B helps you get the care you need for a lot of the other “stuff” that requires a doctor’s care. And you can receive care from any doctor who accepts Medicare patients.
Original Medicare Part B helps cover:
- Medically necessary doctors’ services
- Outpatient care (even if you receive that care in a hospital)
- Chiropractic care, if medically necessary
- Home health services
- Mental health services
- Ambulance service
- Durable medical equipment, which may include crutches, walkers, hospital beds, ventilators and other equipment you may need outside of a hospital
Original Medicare Part B also helps cover a number of preventive services (if you qualify by age, gender or risk factors). These may include:
- Annual Wellness Visits
- Flu, COVID-19, hepatitis B and pneumonia vaccines
- Diabetes screenings
- Depression screenings
- Colorectal cancer screenings
- Bone mass measurements
- Pap tests and pelvic exams
What services are not covered by Medicare Part B?
If you or your doctor aren’t sure if a particular test, item or service is covered, Medicare offers a helpful site where you can verify your coverage.
How much does Medicare Part B cost?
Medicare Part B premiums
Generally, most 2023 Medicare members must pay a monthly Part B premium of $164.90.
Your Part B premium could be higher depending on your income. If your modified adjusted gross income from 2 years ago is above a certain amount, you’ll pay the standard premium plus what’s called an “Income Related Monthly Adjustment Amount” (IRMAA). To see if this applies to you, look at your past income tax return. You’ll find your modified adjusted gross income there.
For most people, paying the premium is simple. Your Part B premium will be automatically deducted from your benefit payment if you get benefits from 1 of these:
- Social Security
- Railroad Retirement Board
- Office of Personnel Management
Medicare Part B deductibles
Like most insurance plans, Medicare Part B does have a standard deductible. In 2023, that deductible is $226. After you meet your deductible for the year, you’ll typically pay 20% of the Medicare-approved amount for most Part B covered services.
Medicare Part B coinsurance
After the deductible, you’ll pay a coinsurance of 20% that will apply to:
- Most doctor services (including most doctor services while you’re a hospital inpatient)
- Outpatient therapy
- Durable Medical Equipment (DME)
- Doctor visits to diagnose a mental health condition
Worried about Medicare costs?
Each state offers Medicare Savings Programs to Medicare beneficiaries whose income falls below a certain level. Most states also consider your assets when determining eligibility. If you qualify, these state-sponsored programs will help pay your monthly Part A or Part B Medicare premiums. These programs will not change your health plan benefits or coverage. They are provided by your state at no cost to you.
Am I eligible for Medicare Part B?
Most people become eligible for Medicare when they turn 65. Some people may qualify before age 65 due to illness or disability. If you’re ready to explore your Medicare options, you can visit Medicare.gov to verify your eligibility. It’s quick and easy.
When can I enroll in Medicare Part B?
Waiting for your 65th birthday to sign up? Good news! You have time to shop.
Your Initial Enrollment Period begins 3 months before the month of your 65th birthday, includes your birthday month, and continues through the 3 months after the month of your 65th birthday. That gives you 7 months to learn about Medicare and compare plans so you can make the right choice for you.
Already have a Medicare plan?
It’s good to remember that choosing a Medicare plan is not a lifetime commitment. Generally, you can join, switch or drop an Original Medicare or Medicare Advantage (Part C) plan during these times:
- Open Enrollment Period. From Oct. 15 – Dec. 7 each year, you can join, switch or drop a plan. Your coverage will begin on Jan. 1 (as long as the plan gets your request by Dec. 7).
- Medicare Advantage Open Enrollment Period. From Jan. 1 – March 31 each year, if you’re enrolled in a Medicare Advantage plan, you can switch to a different Medicare Advantage plan or switch to Original Medicare.
- Special Enrollment Period. You can make changes to your Medicare Advantage and Medicare prescription drug coverage when certain events happen in your life, like if you move or you lose other insurance coverage.
Avoid a Medicare Part B late enrollment penalty. If you don’t enroll in Medicare Part B as soon as you’re eligible—and you don’t have other “creditable coverage,”—you could be assessed a late enrollment penalty when you do enroll. The penalty could be as high as a 10% increase in your premium for each 12-month period that you were eligible but not enrolled.
You can delay enrolling in Medicare Part B—with no penalty—if you’re working and already covered by your employer’s private health insurance. After your employment health coverage ends, you have 8 months to sign up for Part B without a late penalty.
Are there alternatives to Medicare Part B?
You can opt for a Medicare Advantage (Medicare Part C) plan. These plans are offered by private insurers—like Humana. They’re required by law to offer all the benefits of Original Medicare Part A and Part B and most also may include coverage for things like prescription drugs and dental, vision and hearing coverage.