Medicare Part B is the portion of Medicare that covers medical services, such as doctor’s visits and chiropractic treatment for back pain, as well as preventive services, including flu shots.
When a person reaches 65 years of age, they qualify for Medicare Part B. They are eligible on the condition that they are a United States citizen or have been a legal resident in the U.S. for at least 5 years.
In this article, we explain what to know about Medicare Part B, including coverage, exclusions, and which out-of-pocket costs to expect.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
According to Medicare.gov, Part B usually covers two categories of services: Medically necessary services and preventive services.
Medically necessary services are those a doctor uses to diagnose or treat an existing medical condition.
For example, Part B covers people visiting a doctor when they feel sick or people with certain chronic medical conditions who are checking up on their progress.
Preventive services can include physical exams and vaccinations.
Part B covers several aspects of medical treatment and preventive screening, including:
- Ambulance services: Medicare provides coverage when a person needs transport to a hospital or skilled nursing facility for medically necessary services.
- Chiropractic services: Part B funds chiropractic treatment for lower back pain.
- Clinical research services: This includes drug trials and treatments.
- Diabetes supplies: Medicare will fund blood sugar test strips and testing monitors.
- Emergency room services: People may need to visit an emergency room when they experience sudden illness or injury. Medicare would fund costs for this type of treatment.
- Medical equipment: Durable medical equipment, such as supplemental oxygen, walkers, and hospital beds, come under the umbrella of Part B coverage.
- Mental health services: Part B covers visits to a psychiatrist or nurse practitioner.
- Screenings: Medicare covers diagnostic bone density screenings, as well as tests for diabetes, glaucoma, and breast cancer.
Medicare does not fund all types of diagnostic and active treatment. To find out what services are available, use the Medicare search function to check coverage.
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
Most people in the U.S. who worked for at least 40 quarters and paid Medicare taxes through their payroll qualify for premium-free Medicare Part A.
However, most people will pay a monthly premium for Medicare Part B.
The premium’s cost depends upon a person’s income before tax. Medicare base their assessment on tax returns two years prior to enrollment.
If a person earns above a certain amount, they will pay an Income Related Monthly Adjustment Amount (IRMAA). This is a surcharge for higher earners who wish to enroll in Medicare.
The base monthly premium for 2021 for those who make $88,000 or less on their individual tax return or $176,000 or less on their joint tax return is $148.50 for 2021. Other examples of income-related adjustments include:
|Gross individual income $||Gross joint income $||Medicare Part B monthly premium $|
|88,001 – 111,000||176,000 – 222,000||207.90|
|111,001 – 138,000||222,001 – 276,000||297.00|
|138,001 – 165,000||276,001 – 330,000||386.00|
|165,001 – less than 500,000||330,001 – 750,000||475.20|
|500,000 or more||750,000 or more||504.90|
These monthly premium calculations assume that a person enrolled in Medicare Part B when they first qualified for it. Some people may have to pay an extra fee for late enrollment, which will increase their premium.
If a person receives benefits from one of the following organizations, the administration will usually pay the Medicare Part B by deducting the premium from their monthly check:
- Office of Personnel Management
- Railroad Retirement Board
- Social Security
Otherwise, a person will get a monthly bill from Medicare that they must pay to receive their benefits.
Once a person has Medicare Part B, they are still responsible for some healthcare costs. In 2021, a $203 deductible applies to Medicare Part B.
After a person meets their deductible, they will usually pay 20% of the Medicare-approved cost for services that include the following:
- doctor’s services, including check-ups and hospital services
- durable medical equipment, such as a walker or wheelchair
- outpatient therapy
Medicare negotiates with doctors, hospitals, and other organizations to keep pricing as low as possible. A doctor accepts the agreed-upon service costs when accepting a Medicare enrollee for treatment.
Medicare Part B does not pay for some services that fall under the coverage of other Parts.
Examples include inpatient hospital services, which Part A funds and most prescription medications, as Part D funds these.
Medicare Part B regularly evaluates which services they will cover. In 2020, for example, they began covering acupuncture for lower back pain for the first time. It does not currently pay for the following:
- cosmetic procedures
- most dental care
- hearing assistance
- long-term care
- prescription drugs
- routine foot care
- vision care
Supplemental Medicare covers out-of-pocket costs for parts A and B.
Both Medicare Advantage and Medigap plans may vary depending on which products and services are available in a person’s area.
A person becomes eligible for Medicare Part B when they reach 65 years of age.
However, people with specific disabilities qualify for Medicare Part B earlier, including those with end stage renal disease and individuals with amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease.
If a person receives benefits from Social Security or the Railroad Retirement Board, these organizations will automatically enroll them in Parts A and B.
Some people may choose to delay enrollment in Part B because other sources provide coverage, such as insurance for which their employer or their spouse’s employer pays.
If a person cannot pay the Medicare Part B premium, they can apply for Extra Help or Medicaid, which helps individuals with a low-income access and pay for insurance.
When a person qualifies for Medicare, they have the option of choosing between traditional Medicare or Medicare Advantage. This is a plan through which private insurance companies offer Medicare-approved services.
Medicare Advantage, or Medicare Part C, provides Medicare Parts A and B, as well as additional services that the insurer might add. These often include prescription drug coverage and other extras, such as dental, hearing, or vision coverage.
Therefore, Medicare Advantage may pay for all or part of the premium for part B. Sometimes, a person will need to continue paying their monthly Part B premium alongside that of Medicare Advantage.
Medicare provides a tool to help people find Medicare and Medicare Advantage plans in their area. This should give some indication of the costs to expect and the services available in a particular area.
Medicare Part B covers medical care for a variety of services. Once a person meets their deductible, they will usually pay 20% of the agreed-upon costs for further services.
If a person is not sure whether Medicare Part B will cover their service, they should contact Medicare or check using this service ahead of the appointment.