What Is Medicare Part B? Medical Insurance Explained
Medicare Part B covers doctor visits, outpatient care, and preventive services. Here is what you need to know about costs, coverage, and enrollment.
What Is Medicare Part B? Medical Insurance Explained
Medicare Part B is the medical insurance component of Original Medicare. Unlike Part A, Part B requires a monthly premium -- but it covers a wide range of outpatient services that most seniors use regularly.
What Medicare Part B Covers
Doctor services: Part B covers medically necessary services from doctors and other healthcare providers, whether you receive care in a doctor's office, outpatient clinic, or hospital.
Outpatient care: This includes outpatient surgery, emergency department visits (when not admitted), observation services, and outpatient mental health care.
Preventive services: Part B covers many preventive services at no cost to you, including annual wellness visits, flu shots, mammograms, colonoscopies, bone density tests, diabetes screenings, and cardiovascular screenings.
Durable medical equipment (DME): Wheelchairs, walkers, hospital beds, oxygen equipment, and blood sugar monitors are covered when medically necessary.
Home health care: Part B covers home health services when you're not homebound (Part A covers home health when you are homebound).
Ambulance services: Covered when other transportation would endanger your health.
Mental health: Outpatient mental health care, including visits to psychiatrists, psychologists, and clinical social workers.
What Part B Does NOT Cover
Part B does not cover routine dental care, dentures, routine vision care, eyeglasses, hearing aids, acupuncture (with limited exceptions), cosmetic surgery, or long-term care.
How Much Does Part B Cost in 2016?
The standard Part B premium in 2016 is $121.80/month for most new enrollees. Higher-income beneficiaries pay more under IRMAA (Income-Related Monthly Adjustment Amount).
The Part B deductible in 2016 is $166/year. After the deductible, you pay 20% of the Medicare-approved amount for most services -- with no out-of-pocket maximum under Original Medicare alone.
The 20% Problem
The 20% coinsurance under Part B has no cap. A $100,000 surgery leaves you with a $20,000 bill. This is why most Medicare beneficiaries add either a Medigap plan (which covers the 20%) or a Medicare Advantage plan (which replaces Original Medicare with capped out-of-pocket costs).
When to Enroll in Part B
You have a 7-month Initial Enrollment Period centered on your 65th birthday. If you delay Part B without qualifying coverage (active employer coverage from a current employer), you'll pay a permanent 10% penalty for each 12-month period of delay.
We do not offer every plan available in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
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About the Author
William Gray
Independent Medicare BrokerUS Air Force Veteran · Florida Medicare Specialist
William Gray is an independent Medicare insurance broker based in Daytona Beach and Palm Coast, FL. A US Air Force veteran (A-10 crew chief, Germany), he spent years in corporate insurance before going independent to serve Florida seniors directly. He has helped more than 1,000 clients across Northeast Florida compare Medicare Advantage, Medigap, and Part D plans — always at no cost to the client.
