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Part B

Part B is the other half of Original Medicare, which is the coverage for most professional services.

Part B, the other half of Original Medicare, is the coverage for most professional services.

Part B generally covers:

  • medically necessary physician and other health care professional services;
  • outpatient hospital;
  • clinical lab and diagnostic tests, therapies, mental health care;
  • medical equipment;
  • medications and supplies provided at the time of physician’s service.

Most individuals who file an application for Social Security or Railroad Retirement benefits 3 months before they turn age 65 or later are automatically enrolled in Part B unless they refuse Part B coverage.

Individuals with disabilities who are under age 65 are automatically enrolled in Part B the earlier of:

  • The month they turn 65 if they have received Social Security or Railroad Retirement benefits for at least 4 months before they turn age 65. They also are given an opportunity to refuse Part B coverage.
  • The month after they have received Social Security or Railroad Retirement disability benefits for 24 months. They also are given an opportunity to refuse Part B coverage

Beneficiaries pay a deductible each year ($183 in 2017), and after the deductible is satisfied, 20% coinsurance on most Part B covered services.

Beneficiaries will have no cost-sharing for most preventive services.

Preventive Services include:

  • One-time “Welcome to Medicare” physical exam
  • Annual wellness visit after 12 mos. enrolled in Part B
  • Immunizations – pneumococcal, hepatitis B, annual flu shot
  • Abdominal aortic aneurysm screening – one time, with referral
  • Alcohol misuse screening – every 12 months for certain individuals
  • Bone mass measurement – every 24 months for certain conditions
  • Cardiovascular screening blood tests – every five years for all persons
  • Mammogram (Breast Cancer Screening) – annual screening for most women * Pap test and pelvic examination – every 24 mos. for all women; every 12 mos. for those at high risk
  • Colorectal cancer screening – four different tests, vary in frequency * Depression Screening – every 12 months
  • Diabetes screenings – up to two per year for those with risk factors
  • Diabetes self-management training – for persons with diabetes
  • Glaucoma testing – once per year for those at high risk
  • Hepatitis C test – once for all. However, for certain people at high risk Medicare also covers yearly repeat.
  • HIV Screening
  • Medical nutrition therapy – for those with diabetes/kidney disease or kidney transplant
  • Intensive Behavioral Therapy for Cardiovascular Disease – one face-to-face visit annually in a primary care setting
  • Obesity Screening and counseling – for certain individuals
  • Prostate cancer screening – every 12 mos. for men over age 50
  • Screening for Sexually Transmitted Infections (STIs) and High Intensity Behavioral Counseling to Prevent STIs – for certain individuals
  • Smoking cessation counseling – for any illness related to tobacco use

Other services and Items that are usually covered:

  • Ambulance services
  • Ambulatory surgical center fees
  • Blood: In most cases, the a Provider gets blood from a blood bank at no charge, and you won't have to pay for it or replace it. If the Provider has to buy blood for you, you must take one of thse actions:
    • Pay the Provider costs for the first 3 units of blood you get in a calendar year OR
    • Have the blood donated
  • Cardiac rehabilitation – for certain situations
  • Chiropractic services – for limited situations
  • Clinical research studies – some costs of certain care in approved studies
  • Defibrillator (implantable automatic)
  • Diabetic supplies
  • Foot exams and treatment for certain diabetics
  • Eyeglasses after cataract surgery – limits apply
  • Hearing and balance exams (no hearing aids)
  • Durable medical equipment – restricted to certain suppliers
  • Home health services in certain situations
  • Kidney dialysis and disease education – certain situations
  • Mental health care (outpatient) – limits apply
  • Occupational and physical therapy – limits apply
  • Prosthetic/Orthotic items
  • Pulmonary rehabilitation for COPD
  • Second surgical opinions
  • Speech-language pathology services
  • Tests like X-rays, MRIs, CT scans
  • Transplant physician services and drugs
  • Emergency room services

You should checkwith your doctors to confirm the medical need for these things.

Things that are NOT covered by Medcare Parts A or B:

  • Acupuncture
  • Routine dental care/dentures
  • Cosmetic surgery
  • Custodial care
  • Health care while traveling outside the US – exceptions apply
  • Hearing aids
  • Orthopedic shoes (with limited exceptions)
  • Outpatient prescription drugs (this is covered under Part D)
  • Routine eye care and eyeglasses
  • Some screening tests and labs
  • Vaccines, except as previously listed (those not covered under Part B may be covered under Part D)
  • Syringes and insulin unless used with an insulin pump (this is covered under Part D)
  • Routine foot care