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Medicare Part B: Costs, Eligibility and What It Covers
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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.
What Does Medicare Part B Cover?
Medicare Part B provides coverage for many routine and preventative 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 advance directive.
- Ambulance services.
- Ambulatory surgical centers.
- Behavioral health integration services (like depression, anxiety or other mental health conditions).
- Chemotherapy.
- Chiropractic services.
- 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.
- COVID-19 vaccines.
- 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 (if you have cataract surgery).
- Foot care.
- 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.
- Physical therapy services.
- Prostate cancer screenings.
- Prosthetic-orthotic items.
- Pulmonary rehabilitation programs.
- Rural health clinic services.
- Second surgical opinions.
- Telehealth.
- Transplants and immunosuppressive drugs.
- Travel care, certain exceptions when you’re traveling outside of the US.
- Virtual check-ins.
- Annual wellness checks.
Preventative 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 (once a year if you’re at high risk).
- Colorectal cancer screenings.
- Counseling to prevent tobacco use.
- Depression screening.
- Diabetes screenings.
- Diabetes self-management training.
- Flu shots.
- Glaucoma tests.
- Hepatitis B shots.
- 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.
- Sexually transmitted infection testing.
- Shots or vaccines.
- Speech language pathology services.
- Surgical dressing services.
What Doesn’t Medicare Part B Cover?
Medicare Part B does not cover:
- Hospital insurance is covered by Medicare Part A.
- Drug coverage is covered by Medicare Part D.
- Hearing aids, dental and vision are covered by 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.”
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.
There may be limits on expenses you pay through supplemental coverage you have through Medicare health care costs. Medicare premiums and out-of-pocket costs often catch retirees by surprise. According to a survey by the Senior Citizens League, a nonpartisan group advocating for seniors, in Alexandra, Virginia, 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?
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.
While there are generally no deductibles and copayments for preventive services, doctors who do not accept Medicare can charge up to 15% above the Medicare-approved amount for the service. In this case you would also be responsible for a 20% co-payment for the doctor’s services.
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:
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:
Applying for Medicare Part B
If you are already receiving Social Security payments, the government assumes you want Medicare Parts A and B and automatically enrolls you prior to your 65th birthday.
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.”
Staton also recommends applying through Medicare’s official website rather than through an office. Online enrollment should take about 5 to 10 minutes. If you have any questions, contact the helpline at 1-800-633-4227.
