What Does Medicare Part B Cover for Me ?

Transitioning to Medicare is a daunting task for many people. Understanding all the different parts, plans, enrollment periods, and more does not always come easy. So, if you’re feeling overwhelmed, you’re not alone.

One of the best places to start is by understanding the different parts of Medicare, especially Medicare Part B. So, what does Medicare Part B cover for you?

What does Medicare Part B cover?

Medicare Part B is one of the four parts that make up the Medicare program, alongside Part A, Part C, and Part D. It helps cover your outpatient care. Fortunately, this includes various services, including lab work, surgeries, doctor visits, certain vaccinations, durable medical equipment, and more.

There are many resources available online with more info on Part B and all the specific services it helps cover. However, a good way to think about Part B is that it covers two main types of services: medically necessary and preventative. Let’s take a closer look at each one.

Medically Necessary Services

Part B typically helps cover services that Medicare considers “medically necessary.” Medicare defines medically necessary as any service needed to monitor, treat, or diagnose a health condition.

This means that Medicare usually does not help cover routine services. For example, many people are surprised that Medicare does not cover a standard physical. Medicare does not typically cover routine bloodwork, dental, vision, or hearing care either.

Preventative Services

Although it can be discouraging to hear that Medicare does not cover routine services, there is some good news. Medicare Part B does offer coverage for a wide range of preventative services. These services are meant to help prevent illness and disease as well as help catch certain health conditions early on.

Some of the most common examples of preventative services covered under Part B include colorectal cancer screenings like colonoscopies, mammograms, cardiovascular disease screenings, diabetes screenings, and more.

In addition to physical health screenings, Part B also helps cover mental health screenings related to conditions like depression, tobacco usage, and alcohol misuse.

How much does Medicare Part B cost?

The costs associated with Medicare Part B include the monthly premium, deductible, and cost-sharing.

Everyone must pay a monthly premium for Part B, excluding those who qualify for Medicaid assistance. Most people pay the standard premium of $170.10 in 2022, but it will decrease to $164.90 in 2023. However, know that if your income level is above a certain threshold, you may pay more for your Part B premium.

The Part B annual deductible is $233 in 2022. In 2023, the deductible will decrease to $226. The other thing to remember with Part B is that it will only cover 80% of the cost of approved services after you meet the deductible. This means you are responsible for the leftover 20%. Although 20% may not seem like a lot, it can add up very quickly, depending on the service.

So, what’s the solution? Fortunately, you can sign up for a Medicare supplemental plan.

Medicare Supplement Plans

Medicare Supplement plans, also known as Medigap plans, help cover the 20%. This 20% can consist of either copays or coinsurance. There are ten different Medigap plans available to varying degrees.

Fortunately, some Medigap plans cover your 20% at full cost, depending on your plan. Private insurance carriers offer these plans and charge a monthly premium. The exact cost of a Medigap plan depends on various factors such as your age, gender, zip code, tobacco, and more.

Medicare Advantage Plans

Medicare Advantage plans are a different way to receive your Medicare benefits. Like Medigap plans, Advantage plans are run by private insurance companies. The important thing to understand here is that when you have an Advantage plan, your healthcare is managed by that company, not the federal government.

However, these Advantage plans are required to offer you the same coverage the federal government offers. So, you should be able to receive the same medically necessary and preventative services through that plan. Just know your costs will likely look a bit different as each Advantage plan differs.

Summary

Part B is important to your health coverage through the Medicare program. It essentially acts as the foundation for your outpatient care, including doctor’s visits, surgeries, blood work, and much more. However, you want to remember that Part B typically only covers medically necessary and approved preventative services according to Medicare’s guidelines.

Lastly, keep in mind that Part B covers only 80% of approved services, so you’ll either want to enroll in a Medicare Supplement plan or an Advantage plan to help cover your costs.