Medicare Part B: What's Covered?

Quick Overview:

Part B generally covers doctor visits and outpatient services.
There is a life-long penalty for not signing up for Part B on-time.
You can delay Part B if you have credible health coverage through an employer.
There is a monthly premium to pay for Part B.

If you are 65 or older, there are two main forms of Medicare that you can access: Part A and Part B. Both components are often used together, as they each cover different types of medical expenses. If you are eligible for premium-free Medicare Part A, you automatically have access to Medicare Part B. Otherwise, Part B eligibility requires you to be a US citizen (or permanent resident) aged 65 or older.

What Does Medicare Part B Cover?

Medicare Part B generally covers medical services and equipment required for your treatment. Part A covers inpatient hospital care, hospice care, nursing home care, and some home health care. In contrast, Part B covers expenses like outpatient care, preventative care, equipment, and ambulance services.

Parts A and B work in tandem by covering different aspects of medical care. While there are certain expenses that neither insurance pays for, like cosmetic surgery and eye exams, both include the most common and essential treatments. Here is a more detailed breakdown of Medicare Part B coverage:

Doctor’s office visits

Part B covers visits to your primary care physician. Additionally, it pays for visits to specialists as long as they are a Medicare-approved provider. If you want to visit a non-approved provider, Part B will not pay for it.

Ambulance Services

While Part A covers hospital care, Medicare Part B covers the cost of the ambulance. This service includes the ambulance ride to and from a medical facility. Part B also covers the medical professionals, equipment, and treatment onboard the vehicle.

Durable Medical Equipment (DME)

Durable Medical Equipment (DME) refers to any device or piece of equipment that helps sustain a high quality of life. Some common examples are wheelchairs, walkers, canes, and shower chairs. However, it can also include more advanced devices like blood sugar monitors and CPAP machines.

Mental Health Care

Medicare Part B pays for outpatient mental health services like therapy, rehab, and some mental health screenings. However, it does not cover self-administered drugs like antidepressants. Coverage for these kinds of medications requires a Medicare Part D plan.

Outpatient Hospital Care

Part B covers outpatient care when you require medical treatment, but do not require inpatient care. These expenses include same-day surgery, emergency room visits, and short-term observatory care. If you need to stay at the hospital, Medicare Part A will likely cover the expenses.

Lab tests and bloodwork

Part B pays for lab tests and bloodwork as long as they occur at a Medicare-approved facility. However, Part B does not cover the cost of blood transfusions. You will need a supplement insurance plan to cover the first three pints of blood of a transfusion.

Preventative Care

Part B does not cover all preventative care, but it does pay for many standard exams and health monitoring services. These services include but are not limited to flu shots, cancer screenings, nutritional therapy, and an annual “wellness” checkup. Part B also covers regular screenings for some substance abuse and mental health disorders.

Learn more: Does Medicare Pay for Nutritional Supplements?

What Is My Cost Sharing?

While Medicare Part B does provide some coverage there is some substantial cost-sharing involved:

Medicare Part B deductible ($240 in 2024)
20% of the remaining costs (no limit)
Part B excess charges

A Medicare Supplement or Medicare Advantage plan would help cover these out-of-pocket costs. There are plan options for any budget. You need both Medicare A and B to have a Supplemental or Advantage plan.

When To Enroll in Medicare Part B

The periods to enroll in Medicare Parts A or B are the same. You are eligible to enroll in Medicare Part B if you are a US citizen who is 65 or older. If you meet these requirements, you can first sign up during the 7-month Initial Enrollment Period. For most people, this begins three months before their 65th birthday and ends three months after.

Continue reading: When to signup for Medicare?

If you’re receiving retirement benefits, you don’t need to worry about signing up; you will automatically be enrolled in Medicare Parts A and B when you turn 65.

If you miss the initial enrollment period and haven’t begun collecting retirement benefits (thus qualifying you for premium-free Medicare Part A), you can enroll in Medicare Part B during the General Enrollment Period. This period begins at the start of every calendar year and continues for three months (January 1st to March 31st).

Agent Tip
If you don’t enroll in Medicare Part B on time, you can be subject to a life-long penalty. If you are unsure if you should sign up you give us a call at 800-208-4974.

Finally, some people can sign up for Part B during a Special Enrollment Period (SEP). SEPs provide a way for people covered under a group health plan to sign up for Part B. However, even if you do have a group health plan, you’re only eligible if you’re working or have finished work within the last eight months.

How to Enroll

There are a few ways to sign up for Medicare Part B. Here are the easiest and most common ways to enroll:

Go to www.SocialSecurity.gov. Click on “Medicare Enrollment” and follow the instructions to enroll.
Call the Social Security Administration at 1-800-772-1213. You can reach a representative anytime between 7 AM and 7 PM, Monday through Friday.
Visit your local Social Security office.

If you worked at the railroad, you can also sign up for Medicare Part B by calling the Railroad Retirement Board at 1-877-772-5772. You can reach an RRB representative anytime between 9 AM and 3:30 PM, Monday through Friday.

Remember that you may not need to do anything to sign up for Medicare Part B. If you are receiving retirement benefits (Social Security or Railroad Retirement Board benefits), you’re automatically signed up for Medicare Parts A and B when you turn 65. You will need to start making payments to ensure that you’re covered.

Delaying Medicare Part B enrollment

Most US citizens over the age of 65 are eligible for premium-free Medicare Part A benefits. However, Part B requires a mandatory monthly premium. As a result, many people choose to delay Medicare Part B enrollment and save money on premiums.

To delay Part B enrollment, you or your spouse must have a group health plan through an employer. As long as the health care plan and employment are maintained, you are not required to sign up for Part B. Once the job ends, you have eight months to sign up for Part B without incurring any late fees.

Continue Reading: When To Delay Medicare?

US citizens who live abroad might also want to delay Part B enrollment, as they cannot use their Medicare benefits. While most citizens living abroad need to sign up for Part B when they turn 65, there is one exception. If you are living abroad and do not qualify for premium-free Medicare Part A, you can delay signing up for Part B. In this situation, you have a grace period of up to three months after the date you return to the US to sign up without penalty.

Medicare Part B Premiums

Medicare premiums are subject to change every year. As of 2024, Part A costs $505 per month. However, most people who qualify for Medicare Part A don’t need to pay monthly premiums.

Unfortunately, you cannot forgo Part B premiums. The current monthly premium for Medicare Part B is $174.70. You are required to make this payment every month to maintain the benefits of Part B.

Read on: Medicare Costs

Conclusion

Part B is one of the simplest ways for senior citizens to pay for outpatient services and other types of care. It covers a wide range of treatments, from mental health checkups to ambulance services. While the monthly premium is low compared to Part A, you do not have the option to waive payments with Part B.

If you have any questions about Medicare Part B, contact Bluewave Insurance today at 800-208-4974!

Medicare Part B Explained