Medicare Part B

Medicare Part B – Coverage

Medicare Part B, also known as Medical Insurance, helps cover medically-necessary services like doctors’ services, outpatient care, home health services, and other medical services. Part B also covers preventive services. Your Medicare Card indicates whether you have Part B. You can also go to Medicare.gov to find out if you have Part B in place.

The following is a list of common services included with Medicare Part-B coverage:

  • Ambulance Services (for medically-necessary services)
  • Ambulatory Surgical Centers
  • Blood
  • Bone Density Testing
  • Cardiac Rehabilitation
  • Chiropractic Services (limited)
  • Clinical Laboratory Services
  • Diabetes Screening, Supplies and Self-Management Training
  • Doctor Services
  • Durable Medical Equipment
  • EKG Screening
  • Emergency Department Services
  • Immunizations (limited to Medicare-approved)
  • Glaucoma Tests
  • HIV Screening
  • Home Health Services
  • Kidney Dialysis Service and Supplies
  • Mammograms (screening)
  • Mental Health Care (outpatient)
  • Non-doctor Services
  • Occupational Therapy
  • Outpatient Medical and Surgical Services and Supplies
  • Pap Tests and Pelvic Exams
  • Physical Exams
  • Physical Therapy
  • Prosthetic/Orthotic Items
  • Pulmonary Rehabilitation
  • Screenings for Abdominal Aortic Aneurysm, Colorectal Cancer, Mammograms, Prostate Cancer, Cardiovascular Disease
  • Tests (other than lab tests)
  • Transplants and Immunosuppressive Drugs

Medicare Part B – Costs & Deductibles

There is a monthly premium for Medicare Part B coverage. Most people will pay the standard premium amount which is $104.90 for those who are enrolling in Medicare in 2013. However, if your modified adjusted gross income as reported on your IRS tax return is above a certain amount, you may pay more.

The Medicare Part B annual deductible for 2013 is $147. After deductible is met, Medicare generally pays 80% and you pay 20% for covered services.

What do I pay for under Medicare Part B services? The following chart will give general information about what you pay if you have Original Medicare and see doctors or providers who accept assignment. You will pay more for doctors or providers who don’t accept assignment.

Medicare Part B: Medical Services per Calendar Year ($104.90 per month base premium)

Service Medicare Pays You Pay
Medical Expenses
INCLUDES TREATMENT IN OR OUT OF THE HOSPITAL, AND OUT PATIENT HOSPITAL TREATMENT, such as: physician’s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic teste, durable medical equipment.
First $147 of Medicare-approved amounts* $0 $147 (Part B Deductible)
Remainder of Medicare-approved amounts Generally 80% 20%
Part B Excess Charges
Above Medicare-approved amounts
$0 All Costs
Blood First 3 pints $0 All Costs
Next $147 of Medicare-approved amounts* $0 $147 (Part B Deductible)
Remainder of Medicare-approved amounts 80% 20%
Clinical Laboratory Services Tests for diagnostic services 100% $0
Parts A and B Service Medicare Pays You Pay
Home Health Care
Medicare-approved services
Medically necessary skilled care services and medical supplies 100% $0
Durable medical equipment
Medicare-approved services
First $147 of Medicare-approved amounts* $0 $147 (Part B Deductible)
Remainder of Medicare-approved amounts 80% 20%

Notes:
* Once you have been billed $147 of Medicare-approved amounts for covered services, your Part B deductible will have been met for the calendar year.