What is Medicare Part B and What Does It Cover?

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What is Medicare Part B and What Does It Cover?

Medicare Part B, sometimes called “medical insurance,” covers services and supplies that are considered medically necessary to treat or prevent a condition or disease. Below you will find information to help you answer the question, “what is Medicare Part B?”.

What is Covered by Medicare Part B?

Part B is called “medical insurance” to differentiate it from Part A, which is often called “hospital insurance.” In general, it covers medically necessary services and supplies that help you heal from disease or injury. It covers the following services:

  • Ambulance services
  • Doctor’s office visits
  • Durable medical equipment
  • Laboratory tests
  • Mental health and chemical dependency care
  • Outpatient (same-day) hospital surgery

It also covers preventive services at no cost to you. “Preventive” refers to care intended to help prevent disease. Here are some common covered services that are considered preventive:

  • Annual wellness visits
  • Cancer screenings
  • Diabetes screenings
  • Flu shots
  • HIV and STD screenings and counseling
  • Nutrition therapy
  • Tobacco cessation counseling

Learn more about its coverage options here.

What is Not Covered by Medicare Part B

Some services are not covered by Part B. In addition to anything not deemed medically necessary, it doesn’t cover the following services:

  • Cosmetic surgery
  • Routine dental care and dentures
  • Acupuncture and alternative medicine
  • Long-term (custodial) care
  • Eye exams for eyeglasses
  • Hearing aids
  • Routine foot care

Who Can Get Coverage?

Anyone who is eligible for Medicare benefits may enroll in Part B coverage. In general, you can get coverage if any of the following are true:

  • You are age 65 or older
  • You have a disability
  • You have End-Stage Renal Disease (ESRD)

You must also be a US citizen or have been a permanent resident for five continuous years.

How Do I Get It?

You are not required to enroll in Part B coverage; it is a voluntary program. If you want coverage, there are specific periods when you can enroll.

  • Initial Enrollment Period: The most common enrollment period begins three months before the month you turn 65 and ends three months after your birthday month. This means you have a total of seven months to enroll.
  • Initial Enrollment Period (Disability): If you’re under 65 and have a disability, you’ll become eligible to enroll after receiving 25 months of disability benefits. Your initial enrollment period will be the three months before and the three months after that 25th month of receiving disability benefits.
  • General Enrollment Period (GEP). Each year during the GEP of January 1 to March 31, you may enroll in Part B coverage. If you enroll during this period, your coverage will begin July 1 of that same year.
  • Special Enrollment Periods (SEP). You’re granted an SEP of eight months after you lose employer- or union-based coverage. If you had employer- or union-based coverage (your own or from a spouse) when you became eligible for Medicare and you didn’t enroll in Part B coverage, you may enroll during the SEP.

What are the Alternatives?

You can enroll in coverage, which is administered by the federal government—but that’s not your only option. You may also enroll in one of the following (but not both):

  • Medicare Advantage (MA) Plan: Offered by private insurance companies, these plans combine Part A and Part B coverage into one plan. You will enroll with and pay a premium to the insurance company in return for benefits. The benefit to this option is that some MA Plans include coverage for services beyond Part A and Part B like dental, vision, and wellness benefits.
  • Medicare Supplement (MS) Plan: MS Plans, also called Medigap, are a range of health plans that help cover the costs that Original Medicare requires you to pay, like deductibles and copayments. You can purchase a Medigap Plan from private insurers.

The Differences between Part A and Part B

The easiest way to compare Part A and Part B coverage is to think of Part A as “hospital insurance” and Part B as “medical insurance.” Part B covers medically necessary services, such as doctor visits, that are not done during an inpatient (overnight or longer) hospital stay.

Learn more about Part B or dive into more detail about what it covers. You can also learn more about how much Medicare Part B is here.

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