Navigating the world of health care can be an overwhelming experience, but understanding Medicare Part B is critical for older Americans seeking comprehensive medical coverage.
Part of the original Medicare program, Medicare Part B has traditionally provided medical insurance to cover the cost of medically necessary doctors’ services, but the program covers so much more and continues to add services as new medical care needs arise, like combatting the COVID-19 pandemic.
[Read: Medicare Enrollment Deadlines You Shouldn’t Miss.]
What Does Medicare Part B Cover?
Medicare Part B provides coverage for many routine and preventive services — some of which may be surprising, like bariatric surgery. However, strict medical criteria must be met before being approved for gastric bypass surgery and laparoscopic banding surgery.
Check out the numerous services covered through Medicare Part B:
Medical services covered:
— Acupuncture.
— Advance care planning, such as an advance directive.
— Ambulance services.
— Ambulatory surgical centers.
— Behavioral health integration services (like depression, anxiety or other mental health conditions).
— Chemotherapy.
— Chronic care management services (if you have two or more serious, chronic conditions).
— Clinical research studies.
— Cognitive assessment and care plan services.
— CPAP devices and therapy.
— Defibrillators.
— Diabetes equipment, supplies and therapeutic shoes.
— Durable medical equipment like hospital beds, oxygen, walkers, wheelchairs, etc.
— Electrocardiogram (EKG) screenings.
— Emergency department services.
— E-visits to allow you to talk to your doctor virtually.
— Eyeglasses or contact lenses (if you have cataract surgery).
— Foot care, including for issues like diabetes-related nerve damage, injuries and deformities.
— Hearing and balance exams.
— Home health services.
— Home infusion therapy and supplies.
— Kidney dialysis and supplies.
— Kidney disease education.
— Laboratory tests.
— Mental health outpatient care.
— Nutrition therapy services.
— Occupational therapy.
— Opioid use treatment services.
— Oral anti-cancer drugs.
— Outpatient hospital services.
— Outpatient medical and surgical services.
— Outpatient rehabilitation services.
— Physician’s services — primary care and specialty.
— Prostate cancer screenings.
— Prosthetic-orthotic items.
— Pulmonary rehabilitation programs.
— Rural health clinic services.
— Second surgical opinions.
— Speech-language pathology services.
— Telehealth.
— Transplants and immunosuppressive drugs.
— Travel care, certain exceptions when you’re traveling outside of the U.S.
— Virtual check-ins.
— Wound care and surgical dressing services.
— Annual wellness checks.
[Read: 5 Steps for Picking a Medicare Plan.]
Preventive services covered:
— Abdominal aortic aneurysm screenings.
— Alcohol misuse screenings and counseling.
— Bone mass measurements.
— Breast cancer exams (once every two years).
— Cardiovascular behavioral therapy (once a year).
— Cardiovascular disease screenings (once every five years).
— Cervical and vaginal cancer screenings (every two years, or once a year if you’re at high risk).
— Colorectal cancer screenings.
— Counseling to prevent tobacco use.
— Depression screening.
— Diabetes self-management training.
— Flu shots.
— Glaucoma tests.
— Hepatitis B shots (for those at medium or high risk).
— Hepatitis B virus infection screenings.
— Hepatitis C screening tests.
— HIV screenings.
— Lung cancer screenings.
— Mammograms.
— Non-laboratory tests such as x-rays, MRIs, CT scans, EKGs, etc.
— Obesity behavioral therapy.
— Pneumococcal shots.
— Principal care management services.
— Prostate cancer screenings.
— Sexually transmitted infection testing.
What Doesn’t Medicare Part B Cover?
Medicare Part B does not cover:
— Hospital insurance, including inpatient hospitalization, skilled nursing facility stays, some home health care and hospice, which is covered by Medicare Part A.
— Prescription drug coverage, which is covered by Medicare Part D.
— Hearing aids, dental and vision, which are covered by some Medicare Part C, or Medicare Advantage, plans.
— Long-term care.
“Medicare Advantage plans bundle Parts A, B and D and often include additional dental, eye and hearing services, as well as fitness programs,” says Edd Staton, a retirement expert and co-author of the book “Mission: Rescue Your Retirement.”
[READ: Medicare Mistakes to Avoid.]
How Much Does Medicare Part B Cost?
Under original Medicare, if the Part B deductible applies, you must pay all costs — up to the Medicare-approved amount until you meet the yearly Part B deductible of $240, an increase of $14 from $226 in 2023.
After you meet your deductible, Medicare begins to pay its share, and you typically pay 20% of the Medicare-approved amount of the service. Keep in mind: There’s no yearly limit on what you pay out of pocket if you have original Medicare.
A Medicare supplement plan, such as Medigap, can help cover some of those costs, though there may be limits on expenses. Medicare premiums and out-of-pocket costs often catch retirees by surprise. According to a survey by the Senior Citizens League, an Alexandria, Virginia-based nonpartisan group advocating for seniors, Medicare-eligible members pay a significant portion of their total household income on health care costs. Among 2,275 respondents to a June 2023 survey, 34% of respondents spent 16% to 29% of their income on medical expenses.
“Affording health care expenses, even with help from Medicare, is still a struggle for many seniors,” says Mary Johnson, a Medicare policy analyst with the Senior Citizens League.
Medicare Part B is only free if you have a low income and are enrolled in one of the Medicare Savings Programs for financial assistance. Eligibility for these programs varies by state.
“The qualification process is more accessible in some states due to elevated income limits or the absence of asset requirements,” Johnson says.
Are there any hidden costs of Medicare Part B?
Be aware that doctors who do not accept Medicare can charge up to 15% above the Medicare-approved amount for the service.
While it’s not a hidden cost, you should also know that higher-income earners must pay a surcharge, called income-related monthly adjustment amount (IRMAA), in addition to the standard Part B premium. This is true for Part D as well. This surcharge is based on income reported two years prior.
For 2024, this additional charge applies to members whose 2022 income exceeded $103,000 for an individual return or $206,000 for a joint return.
Medicare Part B Premiums
The Centers for Medicare & Medicaid Services announced that the standard monthly Part B premium will be $174.70 in 2024, an increase of $9.80 from $164.90 in 2023.
Premiums start rising as income increases as follows:
| Beneficiaries who file individual tax returns with modified gross income: | Beneficiaries who file joint tax returns with modified gross income: | Income-related monthly adjustment amount | Total monthly premium amount |
| Less than or equal to $103,000 | Less than or equal to $206,000 | $0.00 | $174.70 |
| Greater than $103,000 and less than or equal to $129,000 | Greater than $206,000 and less than or equal to $258,000 | $69.90 | $244.60 |
| Greater than $129,000 and less than or equal to $161,000 | Greater than $258,000 and less than or equal to $322,000 | $174.70 | $349.40 |
| Greater than $161,000 and less than or equal to $193,000 | Greater than $322,000 and less than or equal to $386,000 | $279.50 | $454.20 |
| Greater than $193,000 and less than $500,000 | Greater than $386,000 and less than $750,000 | $384.30 | $559.00 |
| Greater than or equal to $500,000 | Greater than or equal to $750,000 | $419.30 | $594.00 |
Medicare Part B Eligibility
Medicare is available to older Americans, but there are special circumstances where younger individuals may also qualify. Specific eligibility requirements include:
— Age 65 and older.
— Younger individuals who have received Social Security Disability benefits for 24 months or who have end-stage renal disease or amyotrophic lateral sclerosis (ALS).
— U.S. citizen or legal permanent resident who has lived in the United States for at least five continuous years.
Applying for Medicare Part B
If you are already receiving Social Security payments, you can receive Medicare Parts A and B, and the government automatically enrolls you prior to your 65th birthday (though if you don’t need Part B, you can decline it).
If you are 65 or older, still working and not yet drawing Social Security, the key determinant for enrolling in Medicare is the size of your employer. If the company has less than 20 employees, you should enroll during the initial enrollment period — from three months before you turn 65 until three months afterwards.
There are two reasons for enrolling, according to Staton.
“First, your small group insurer might be able to refuse to pay any portion of claims that Medicare would have paid. Secondly, whenever you do enroll in Medicare, you will be subject to a lifelong late enrollment penalty on Part B that continues to increase every year you delay,” Staton explains. “If you are contributing to a health savings account, you cannot enroll in Medicare because to contribute pre-tax dollars you cannot have health insurance other than a high-deductible health plan.”
However, if you have employer coverage, you can sign up for Medicare without a penalty after you retire. Once you’re enrolled, keep in mind that you are also no longer eligible to contribute to a health savings account.
To enroll in Medicare, visit the Social Security website, or check out Medicare.gov for additional resources.
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Medicare Part B: Costs, Eligibility and What It Covers originally appeared on usnews.com
Update 01/26/24: This story was previously published at an earlier date and has been updated with new information.
