Medicare has an alphabet soup of parts that can be very confusing at first glance. So to make it easier, we’ve put together a list of information that outlines what Medicare Part B covers, along with information regarding enrollment, costs, and eligibility requirements to keep in mind.
Generally speaking, Medicare benefits under Part B will cover outpatient medical care, and this includes the necessary services you need to treat a medical condition or disease. It also pays for preventative care like certain vaccines, screenings, and mental health counseling. You can use it to go to your annual wellness visits or checkups, and you get services like flu shots to help prevent you from getting sick.
What Medicare Part B Covers
Part B will cover 80% of certain services at the Medicare-approved amount as long as you visit a physician that accepts assignment. Most of these services are done on an outpatient basis, but not all of them. (Services you get while you’re staying as an inpatient in a hospital will be covered by Part A). A Medicare-approved supplier has to administer your care for approval, like an NP, DO, MD, or other medical professionals.
Services that Medicare Part B cover may include:
- Certain prescription drugs a physician administers or those that you get intravenously in an outpatient or inpatient setting
- Chiropractic care for a spinal subluxation
- Diagnostic mammograms for men and women
- Durable medical equipment
- Emergency transportation like an ambulance
- Hepatitis B vaccine if you’re someone who is at high risk for contracting it
- Laboratory testing like blood work
- Medically necessary outpatient hospital care, like emergency room visits or same-day surgical procedures
- Mental health services
- Most doctor visits if they’re preventative or medically necessary as long as they’re from a Medicare-approved supplier
- Pap smears
- Preventative mammograms for women
- Smoking cessation counseling
- Some home health services
- Some nonemergency transportation services
- Some vaccines like an annual flu shot or pneumonia shot
Additionally, Medicare benefits under Part B can cover tests and screenings for several conditions, including:
- Alcohol misuse
- Heart disease
- Hepatitis C
- Lung cancer and other cancers
- Sexually transmitted infections
Medicare Part B Eligibility
To be eligible for coverage under Part B, you have to be at least 65 years old, unless you qualify under the age of 65 due to certain disabilities. Additionally, you have to be a permanent resident of the United States who has lived here for at least five consecutive years or be a citizen of the United States to sign up for Medicare.
Medicare Part B Eligibility Exceptions
Being 65 years old or older isn’t a hard requirement for being eligible for Part B coverage. You’re eligible if you’re under 65 and you have gotten Railroad Retirement Board disability benefits or Social Security disability benefits for a minimum of 24 months. In addition, anyone who has End-Stage Renal Disease or Amyotrophic Lateral Sclerosis is eligible for Part B no matter their age.
Medicare Part B Costs
During 2022, Medicare Part B’s annual out-of-pocket deductible is $233. You have to pay this amount before it covers any medically necessary services. Along with this annual deductible, you’ll have to pay a monthly premium. This amount is $170.10 for 2022. Anyone who is still working and has an annual income of $91,000 or higher will pay a higher premium. If you’re married and your combined income is higher than $182,000, the premium can be higher.
Part B will cover outpatient care like doctor visits. This coverage also extends to any preventive and medically necessary care, and you’ll pay a monthly premium and annual deductible for Part B.