Original Medicare Part B

Part A, or hospital coverage, is the most basic form of coverage under the Medicare program.  Part A is considered “bare bones” coverage because it only helps you if you have an emergency and end up at a hospital. It does not cover health needs like doctor’s appointments or prescription medication to be taken at home. You may think that Part A doesn’t cover quite enough — and that’s where Medicare Part B comes in.

How is Part B Different From Part A?

While Part A is limited to care at hospitals, rehabilitation centers and nursing facilities (not nursing homes), Part B fills the gap by covering non-emergency health care, such as doctor’s appointments and medical devices. Simply put, Part B is medical insurance that covers your everyday, regular healthcare needs and preventative services.

Part B coverage is also different because enrollment is voluntary. Part B gives you more options and resources but it does come with a monthly premium.  In 2016, this monthly premium is $104.90.

To reiterate, you generally do not pay for Part A, it’s a benefit that you have earned by paying taxes while working, but you do pay for Part B.


What Does Medicare Part B Provide?

Because Part B offers more coverage for health services you are likely to use frequently, it covers much more than Part A. Part B is considered medical insurance (unlike Part A which is hospital insurance), most medical services you need are covered. Part B also covers preventative services, so that even if you aren’t sick, you can visit a doctor to prevent future health conditions.

Medically Necessary Services and Items

These are care services you need from a doctor, nurse or physician to diagnose an ailment or treat a health condition. This includes x-rays and laboratory tests. Part B also considers any supplies you need for a health condition, such as catheters or diabetic testing supplies. Unfortunately, this does not include glasses, hearing aids or dentures — all things that Medicare generally does not cover at all.  Typically dental, vision, and hearing is covered by plans purchased through private insurance companies.  The Medicare Specialists at PolicyZip are well-versed in helping seniors find coverage for these items.  Call (844) 205-7510 to speak with a specialist or fill out the form below.

Preventative Services

Sometimes, you may go to the doctor not because you are sick, but to monitor symptoms or screen for potential health problems such as diabetes, heart attack or stroke. Part B covers preventative services so that you and your doctor can work together to prevent or delay health conditions. Some of these services may include blood testing, mammograms and various other screenings. Not  all preventative services have to be for major health conditions. Services as simple as flu shots are considered preventative healthcare because they working to keep you from getting sick (and potentially causing more serious health issues).

Ambulance Services

If you need to use an ambulance, Medicare Part B will help cover the cost. This is both for emergency situations where you call for an ambulance, or for times you may need to be transported from one hospital or medical facility to another location. Generally, Original Medicare will pay for up to 80% of ambulance services.

Clinical Research

Medicare Part B will cover clinical research studies that test different kinds of care techniques or medications. The only hitch is that the study must fit certain research qualifications to be covered. Medicare covers clinical research because it gives you more health care options while also helping doctors and researchers determine if new treatments are working and can be expanded to other patients.

Durable Medical Equipment (DME)

If you need medical equipment that will be used for a long period of time — known as Durable Medical Equipment — Part B will help to cover some or most of the cost. You must need the device for a medical reason and may need to use it in your home. Some Durable Medical Equipment covered by Part B includes blood sugar monitors, crutches, hospital beds, wheelchairs, walkers and sleep apnea machines.

Mental Health Services

Part B provides coverage for mental health services that are administered outside of a hospital, such as at a doctor’s office. This includes psychiatrists, psychologists and clinical social workers. Plan B will cover outpatient mental health services, too, such as therapy, counseling and substance abuse treatment.

Second Opinions

If a doctor tells you that you need surgery, but you would like to seek out a second opinion, Part B will help cover this expense. Because of this, there’s no reason to feel you can’t get another doctor’s opinion on your health situation.

Some Prescription Medications

Part B generally does not cover prescription medications. But, if you require a drug that can only be taken at a doctor’s office or other health care facility, this may be covered.  Drug coverage is often obtained through a separate drug plan.  Contact a Medicare Specialist at PolicyZip by calling (844) 205-7510 or filling out the form below to learn more about prescription drug coverage options.

What Does Original Medicare Part B Not Cover?

While Part B is meant to fill some coverage gaps left by Part A, it by no means covers everyhting. Part B provides access to doctors’ offices, preventative services and some medical supplies, but it doesn’t cover commonly needed items such as eye glasses and contacts, hearing aids or dentures. Other non-covered items include:

  • Prescription medications you take at home
  • Over-the-counter medications
  • Hearing aids and hearing exams
  • Glasses, contacts and eye exams
  • Dentures and dental work
  • Long-term care not related to an illness
  • Cosmetic surgery
  • Acupuncture


Understanding the Cost of Part B

Original Medicare Part B is different from Part A in that it costs a monthly premium. Most people pay a standard rate, though individuals with higher income may pay more (this amount changes annually). There are two ways to pay your premium: through billing or by automatic deduction. If you receive a Social Security or retirement check, your premium will be taken from those funds. But, if you are not received social security retirement benefits yet, you will receive a monthly bill for your premium.

If you sign up for Part B, you’ll also have a yearly deductible — the amount you must first pay out of pocket before Medicare will begin pitching in. After your deductible is met, you’ll generally pay 20% of the cost for healthcare services and needs, and Medicare will pay the remaining 80%.  Many Medicare beneficiaries see value in purchasing a Medicare Supplement plan to limit their financial exposure on this 20% coinsurance and replace some or all of their deductible.  PolicyZip specializes in helping Medicare beneficiaries compare coverage options and find the right mix of affordability and coverage.  Connect with a Medicare Specialist by calling (844) 205-7510 or by filling out the form below.