Definition: Medicare Part B is the portion of Original Medicare that provides coverage for outpatient medical services, including doctor visits, preventive screenings, diagnostic tests, durable medical equipment, and certain home health and mental health services.
Understanding what Medicare Part B covers is critical for seniors, people with disabilities, and caregivers making healthcare decisions. Medicare Part B, part of Original Medicare, covers a wide range of outpatient medical services, including doctor visits, specialist consultations, lab tests, imaging, preventive screenings, durable medical equipment, and certain home health and mental health services.
Knowing your Part B coverage empowers you to make informed healthcare choices, avoid unexpected medical bills, and maximize the benefits available.
With rising healthcare costs, understanding the scope of Medicare Part B coverage ensures you receive the care you need while managing out-of-pocket expenses.
This guide covers everything you need to know about Medicare Part B benefits, including services covered, costs, exclusions, and tips for maximizing your plan.
Overview of Medicare Part B Coverage
Medicare Part B focuses on medical insurance for outpatient care, helping beneficiaries access doctor visits, preventive care, diagnostic tests, and medically necessary treatments. While Part A covers hospital services, Part B ensures you receive care outside the hospital, making it essential for ongoing health management.
Key Services Covered by Part B:
- Doctor Visits: Primary care and specialist consultations, including telehealth visits.
- Preventive Services: Screenings, vaccines, and wellness exams.
- Diagnostic Tests and Lab Services: Blood work, X-rays, MRIs, and other medically necessary tests.
- Outpatient Procedures: Minor surgeries, physical therapy, chemotherapy, and dialysis.
- Durable Medical Equipment (DME): Wheelchairs, walkers, oxygen equipment, and other prescribed devices.
- Home Health Services: Skilled nursing, physical therapy, or therapy at home when medically necessary.
Part B helps maintain long-term health and prevent serious conditions. Many preventive services are fully covered, while other treatments involve copayments, coinsurance, or deductibles.
Doctor Visits and Specialist Services Covered by Medicare Part B
Part B ensures beneficiaries can access primary care doctors and specialists when medically necessary, which is essential for chronic condition management and preventive health.
Primary Care Visits: Routine check-ups, consultations, and follow-ups are covered. Annual Wellness Visits are fully covered without copayments.
Specialist Visits: Cardiologists, dermatologists, orthopedic doctors, and other specialists are included. Visits require coinsurance or copays after meeting your deductible.
Telehealth Services: Covered under Part B, especially for seniors in rural areas or with mobility limitations.
Costs:
- Copayment/Coinsurance: Typically 20% after the Part B deductible.
- Deductible: Beneficiaries pay an annual deductible before most services are covered.
Example: Visiting a cardiologist for routine heart monitoring is covered, with you paying only coinsurance after the deductible.
Preventive Services Covered by Medicare Part B
Preventive care is a cornerstone of Medicare Part B coverage. Many services are fully covered to catch health issues early.
Covered Preventive Services:
- Annual Wellness Visit
- Vaccinations: Flu, pneumonia, COVID-19, shingles
- Cancer Screenings: Mammograms, Pap tests, colonoscopies, prostate screenings
- Diabetes, Cholesterol, and Blood Pressure Screening
- Bone Density Tests
- Depression and Mental Health Screening
- Obesity and Lifestyle Counseling
Costs: Preventive services are often fully covered. Some diagnostic tests related to prevention may involve coinsurance.
Example: A 65-year-old beneficiary can get a mammogram and flu shot with $0 out-of-pocket cost.
Diagnostic Tests and Lab Services Covered by Medicare Part B
Part B covers medically necessary diagnostic tests and lab services, including:
- Blood Tests: CBC, cholesterol, glucose tests
- Urine Tests: Kidney function, infection screenings
- Imaging: X-rays, MRIs, CT scans, ultrasounds
- Heart Tests: EKGs, echocardiograms
- Other Lab Services: Pathology tests, cultures
Coverage Rules: Tests must be medically necessary and ordered by a Medicare-approved provider. Preventive lab screenings may be fully covered.
Costs: After the Part B deductible, beneficiaries pay 20% coinsurance.
Example: A doctor orders a CT scan for abdominal pain. Part B covers it if medically necessary, with the patient paying coinsurance.
Outpatient Services and Procedures Covered by Medicare Part B
Part B covers outpatient surgeries and procedures, including:
- Minor surgeries (e.g., cataract removal)
- Physical and occupational therapy
- Chemotherapy and radiation therapy
- Dialysis for kidney failure
- Emergency outpatient care
- Ambulatory surgical centers
Coverage Rules: Services must be medically necessary. Part B generally covers 80% of approved costs after the deductible.
Example: Outpatient physical therapy after knee surgery: Medicare covers 80% of the session cost.
Durable Medical Equipment (DME) Covered by Medicare Part B
DME covered by Part B includes:
- Mobility Aids: Wheelchairs, walkers, canes
- Hospital Beds
- Oxygen Equipment
- Blood Sugar Monitors and Insulin Pumps
- CPAP Machines
- Other Physician-Prescribed Devices
Coverage Rules:
- Must be medically necessary and prescribed by a doctor
- Must be purchased from Medicare-approved suppliers
- Beneficiary pays 20% coinsurance after deductible
Example: A $1,000 wheelchair: Medicare Part B covers $800, the patient pays $200 plus deductible.
Mental Health Services Covered by Medicare Part B
Part B covers outpatient mental health services, including:
- Individual and group therapy
- Psychiatric evaluations
- Office-administered medications
- Tele-mental health services
- Partial hospitalization programs
Costs: Typically 20% coinsurance after deductible; preventive screenings often fully covered.
Example: Weekly therapy sessions for depression are covered, with patient paying 20% coinsurance after deductible.
Home Health Services Covered by Medicare Part B
Home health services include:
- Skilled nursing care
- Physical therapy
- Occupational therapy
- Speech-language pathology
- Medical social services
- Home health aide services (when combined with skilled care)
Eligibility: Must be homebound and medically necessary.
Costs: Part B covers 80% of approved services after deductible.
Example: Post-hip surgery physical therapy at home is covered under Part B.
Costs and Out-of-Pocket Expenses for Medicare Part B
Monthly Premiums:
- Standard premium: ~$174.70 (2023), adjusted annually
- Medicare Part B premium 2024, 2025, and 2026 premiums vary based on income
- Higher-income beneficiaries pay IRMAA
Deductibles:
- 2025 Medicare Part B deductible: $226
- 2026 Medicare Part B deductible: subject to update
- Preventive care often not subject to deductible
Coinsurance and Copays:
- Beneficiaries pay 20% after deductible for most services
Supplemental Coverage:
- Medigap or Medicare Advantage can cover coinsurance, copays, and excluded services
Example: Outpatient chemotherapy costing $1,000: Part B covers $800, patient pays $200 after deductible.
What Medicare Part B Does NOT Cover
- Dental care
- Routine vision care
- Hearing aids
- Long-term care
- Cosmetic surgery
- Routine foot care
- Prescription drugs (covered under Part D)
Planning: Consider Medigap, Medicare Advantage, or separate dental/vision plans.
Example: Dentures are not covered, requiring supplemental insurance or out-of-pocket payment.
Tips to Maximize Medicare Part B Benefits
- Schedule preventive care on time
- Use Medicare-approved providers
- Utilize telehealth services
- Consider supplemental insurance (Medigap/Advantage)
- Track deductibles and coinsurance
- Stay updated on coverage changes
Example: Scheduling an annual wellness visit and flu shot early in the year maximizes fully covered preventive services.
FAQs About Medicare Part B
1. Does Medicare Part B cover dental care? No, except medically necessary procedures.
2. Are vaccines included? Yes: flu, pneumonia, COVID-19, shingles.
3. How much is the Medicare Part B deductible for 2025? $226.
4. Does Part B cover physical therapy? Yes, when medically necessary.
5. Can Part B cover telehealth? Yes, for certain visits.
6. Is mental health care covered? Outpatient therapy is, with coinsurance; preventive screenings often free.
7. How does Part B work with Part D? Office-administered meds covered by Part B; home prescriptions usually Part D.
8. Can I get Medicare Part B for free? Certain low-income beneficiaries may qualify for assistance programs.
Conclusion
Understanding what Medicare Part B covers is essential for seniors, people with disabilities, and caregivers.
Part B provides outpatient medical services, preventive care, diagnostic tests, durable medical equipment, mental health, and home health services.
Knowing costs such as monthly premiums, deductibles, and coinsurance including 2023, 2024, 2025, and 2026 Medicare Part B premiums helps you plan effectively.
By staying informed, scheduling preventive visits, using Medicare-approved providers, and considering supplemental coverage, you can maximize Part B benefits and manage out-of-pocket costs.
This ensures you maintain your health, avoid surprises, and make confident healthcare decisions.
