What does Medicare Part B cover?

What medical services, like doctor’s visits and preventive care, are included in Medicare Part B?

Medicare Part B covers a wide range of medical services, including doctor’s visits, outpatient care, preventive services, and certain medical equipment. Here’s an overview of what’s included in Medicare Part B coverage:

1. Doctor’s Visits:

• Medicare Part B covers doctor’s visits, including:

  • Primary care visits.

  • Specialist visits (with or without a referral, depending on your healthcare provider).

  • Telehealth visits for certain services, such as routine check-ups or consultations.

• You are responsible for a 20% coinsurance of the Medicare-approved amount for most services, after meeting your Part B deductible, which is $240 in 2024.

2. Preventive Care:

• Part B offers a variety of preventive services to help maintain your health and detect potential issues early. These services are typically covered at no cost to you if your healthcare provider accepts Medicare:

  • Annual Wellness Visit: A yearly check-up to create or update your personalized prevention plan.

  • Flu Shots: Annual influenza vaccines.

  • COVID-19 Vaccines: Vaccines to protect against COVID-19.

  • Pneumococcal Vaccines: Vaccines to protect against pneumonia.

  • Screenings:

    • Mammograms (for breast cancer).

    • Colorectal cancer screenings, including colonoscopies.

    • Cardiovascular disease screenings.

    • Diabetes screenings.

    • Bone density tests.

    • Depression screenings.

  • Smoking cessation counseling to help you quit smoking.

  • Obesity counseling and weight loss programs if medically necessary.

3. Outpatient Care:

• Outpatient services are covered under Part B when you don’t require an overnight stay in a hospital or facility. This includes:

  • Diagnostic tests: X-rays, MRIs, CT scans, and other imaging tests.

  • Lab tests: Blood tests, urinalysis, and other laboratory services.

  • Outpatient surgery: Minor procedures performed in an outpatient clinic or hospital without an overnight stay.

  • Emergency room visits: For treatment of urgent medical conditions not requiring admission.

4. Durable Medical Equipment (DME):

• Medicare Part B covers durable medical equipment (DME) if prescribed by your doctor for use at home. Some examples include:

  • Wheelchairs and walkers.

  • Oxygen equipment.

  • Blood sugar monitors and test strips for individuals with diabetes.

  • Hospital beds and commodes.

  • Prosthetic devices.

• You typically pay 20% coinsurance after meeting your deductible for DME.

5. Mental Health Services:

• Medicare Part B covers outpatient mental health services, including:

  • Counseling and therapy: Visits with licensed therapists, psychologists, or social workers.

  • Psychiatric services: Appointments with psychiatrists or other mental health professionals for diagnosis and treatment.

  • Screenings: Annual depression screenings are fully covered.

6. Physical, Occupational, and Speech Therapy:

• Physical therapy: For rehabilitation following surgery, injury, or illness.

• Occupational therapy: To help with daily living activities and skills.

• Speech therapy: For individuals with speech, language, or swallowing disorders.

7. Ambulance Services:

• Medicare Part B covers ambulance services when emergency transport to a hospital or skilled nursing facility is medically necessary and no other transportation method would suffice. Non-emergency transportation may be covered under certain conditions (e.g., dialysis treatments).

8. Home Health Services:

• If your doctor certifies that you’re homebound and need skilled care, Medicare Part B covers limited home health services, such as:

  • Intermittent skilled nursing care.

  • Physical, speech, and occupational therapy.

  • Medical social services.

• Personal care services (like help with bathing or dressing) are not covered unless they are provided as part of skilled care.

9. Chemotherapy and Other Cancer Treatments:

• Part B covers chemotherapy and other cancer treatments administered in an outpatient setting, such as radiation therapy and immunotherapy. You typically pay 20% coinsurance for these treatments.

10. Vaccinations and Immunizations:

• In addition to flu and pneumococcal vaccines, Medicare Part B covers vaccines for:

  • Hepatitis B (if you are at medium or high risk).

  • Shingles (through Part D, not Part B).

  • Tetanus (in the case of injury).

Key Takeaways:

• Medicare Part B covers doctor’s visits, preventive care, outpatient services, mental health care, and durable medical equipment.

• You generally pay 20% coinsurance for services after meeting your annual deductible.

• Many preventive services are covered at no cost to you if you visit a Medicare-approved provider.

For personalized assistance in understanding your Medicare Part B coverage or selecting the right services for your needs, schedule an appointment with a Tsunami Advisor here: Schedule an Appointment.