Medicare Part B is the medical insurance portion of Medicare, which covers physician services, outpatient hospital care, and many other services typically covered under health insurance plans. Part B is financed through monthly premiums paid by enrollees and by contributions from the federal government.
What is the Cost to Enrollees?
In 2017, the standard Part B premium is $134 per month, or higher depending on your income. Most people pay less if they are receiving Social Security benefits due to the fact that the Part B premium increased more than the cost of living allowance (COLA) provided by Social Security this year. If you pay your Part B premium through your monthly Social Security benefit, you’ll pay less ($109 on average). Due to a provision in the Social Security Act, you are “held harmless” from Part B premium increases when no Social Security COLA is payable.
Unfortunately, this is not the case for the approximately 30% of Medicare beneficiaries who are not subject to this “hold harmless” provision. If you fall into the following groups, you may pay more for Medicare Part B in 2017:
- You enroll in Part B for the first time in 2017.
- You don’t get Social Security benefits.
- You have Medicare and Medicaid, and Medicaid pays your premiums.
- Your modified adjusted gross income as reported on your federal income tax return from two years ago is above a certain amount.
The Medicare Part B deductible is $183 in 2017.
What does Medicare Part B Cover?
Medical care that is not inpatient is usually covered under Medicare Part B. Medicare Part B covers 80 percent of medically necessary physician or outpatient charges, including charges from a physician for care received in a hospital. The Part B deductible generally applies.
Services Covered Under Medicare Part B
Currently, services covered under Medicare Part B (the 20 percent coinsurance charge and deductible generally apply) include:
- Physician and surgeon fees
- Outpatient services
- Immunosuppressive drugs
- Blood service, after you pay for the first three pints of blood in any calendar year
- Clinical laboratory services
- Some coverage for outpatient mental health visits
- Certain medically-necessary home health services
- Physical and occupational therapy
- Ambulance service
Medicare also fully covers the cost of most preventive services (beneficiaries will pay nothing out-of-pocket) if a health-care provider accepts assignment. Some services are limited to one per year. The preventive services Medicare fully covers include:
- An annual wellness exam to develop or update a personalized prevention plan
- Annual mammograms for individuals age 40 or older, and a baseline mammogram for individuals between ages 35 and 39
- Pap test and pelvic exams
- Pneumococcal and flu vaccines
- Hepatitis B vaccines for high-risk individuals
- HIV screening test
- Colorectal cancer screening test
- Diabetes screening test
- Cardiovascular screening test
- Bone density measurements for women at risk for osteoporosis
- Self-management training for individuals with diabetes
- Medical nutrition therapy for individuals with diabetes or kidney disease
- Smoking cessation counseling if you haven’t yet been diagnosed with a tobacco-related illness
- Depression screening (test is fully covered; you generally have to pay 20 percent for doctor’s visit)
- Alcohol misuse screening and counseling
- Obesity screening and counseling
Services Excluded From Medicare Part B Coverage
In general, Medicare pays only for services it considers reasonable or medically necessary. Specific exclusions include:
- Cosmetic surgery, unless particular medical conditions render it necessary
- Procedures considered experimental
- Hearing aids and fittings
- Chiropractic services, except for treatment of subluxation (partial dislocation) of the spine
- Most eyeglasses and eye exams
- Most dentures and dental care
- Prescription drugs you administer yourself, such as those you buy at a drug store and take at home (exceptions are immunosuppressive drugs and antirejection drugs for kidney transplant patients)
- Over-the-counter drugs
- Care outside of the United States (except when a Mexican or Canadian hospital is closer, such as in an emergency, even though you reside in the United States, or if you require care while traveling through Canada en route to Alaska)
Prescription drug coverage is available under Medicare Part D (prescription drug coverage).
You can get further information about coverage under Medicare Part B by calling the Social Security Administration at (800) 772-1213 or by visiting www.ssa.gov (the Social Security Administration website) or www.medicare.gov.
Medicare.org is here to help you find the Medicare insurance coverage that meets your needs. If you have questions or need help finding quality coverage at a price you can afford, call one of our licensed sales agents at (888) 815-3313 — TTY 711.