Regular consultation with your doctor can be a cornerstone of good health. If you’re on Medicare, Part B coverage helps you pay for doctor visits, as well as other outpatient services and supplies.
Let’s take a closer look at what Part B covers, what it doesn’t and what it will cost you out of pocket.
What is Medicare Part B?
Medicare Part B pays for doctor visits, diagnostic tests and other outpatient services and supplies.
Part B, along with Medicare Part A, is sometimes called Original Medicare. While Part B covers outpatient services, Part A pays for inpatient treatment at hospitals, as well as skilled nursing care, hospice care and home care.
If you have Part B, you’ll pay a monthly premium, and have a yearly deductible and coinsurance costs, but you won’t have to pay for most preventative care, such as vaccines and screenings.
What does Medicare Part B cover?
Part B covers two types of services: Medically necessary services and preventative services.
To be medically necessary, a service or supply must meet accepted medical standards and be required to diagnose or treat a medical condition. These services include clinical trials, ambulance services, mental health services, outpatient hospital services, some prescription drugs and durable medical equipment, such as a wheelchair or walker for use at home.
Preventative services comprise wellness visits, some vaccinations and screenings related to mental health, cancer and other health conditions. Most preventative services are free if the provider accepts assignment, meaning they will take payment of the Medicare-approved amount for the service directly from Medicare.
Under Part B, you can choose any doctor, health care provider, hospital or facility that is enrolled in Medicare and is taking new patients. Generally, if you want to see a specialist, you don’t need a referral.
What doesn’t Medicare Part B cover?
Part B doesn’t cover inpatient care at a hospital or skilled nursing facility, hospice care or home care. Part A pays for those services.
Nor does Part B cover most prescription drugs. If you want prescription drug coverage, you’ll need a Medicare Part C (Medicare Advantage) or Part D (prescription drug) plan.
Additionally, Part B doesn’t cover long-term care, cosmetic surgery, routine foot care or most dental, hearing and vision care.
What does Medicare Part B cost?
With Medicare Part B, you’ll pay a monthly premium and have a yearly deductible and coinsurance payments.
Part B premiums
The standard Part B premium is $170.10 a month in 2022, but you’ll pay more if your annual income exceeds $91,000 (individual) or $182,000 (joint). If you don’t sign up for Part B when you’re first eligible, you could also pay a higher premium as a penalty.
Part B deductible and coinsurance
The annual Part B deductible is $233. After meeting the deductible, you typically will pay 20 percent of the Medicare-approved amount for most doctor services, outpatient therapy and durable medical equipment. You pay nothing for home care services, clinical laboratory services and most preventative services.
You can choose to buy Part B without buying Part A. But you usually have to buy Part B if you’ve already purchased Part A, and you will pay premiums for both.
What’s the difference between Medicare Part B and Medicare Part A?
Part B and Part A comprise Original Medicare, but they cover different things. Part B is medical insurance and covers outpatient care, including doctor visits, screenings and medical supplies.
Part A, sometimes called hospital insurance, covers inpatient care at a hospital or skilled nursing facility, as well as hospice care and home care.
Where can I find a primary care physician who accepts Medicare patients?
NewPrimaryCare.com™ can help you find a quality Medicare primary care doctor near you. All of our providers practice value-based care, meaning Medicare rewards them for helping patients get healthier, rather than for the number of patients they treat. With a value-based care provider, you can expect quicker appointment scheduling, shorter waits at the doctor’s office and a meaningful connection with your physician.
Use our Find Your Doctor tool to search for and compare value-based care providers near you.
