Overview of Medicare: Part B

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Many people in Medicare never need to go into the hospital, but almost everybody sees a doctor or needs diagnostic screenings and lab tests sooner or later. That’s where Part B — known as medical insurance — comes in. The wide range of services it covers includes

  • Approved medical and surgical services from any doctor anywhere in the nation who accepts Medicare patients, whether those services are provided in a doctor’s office, hospital, long-term care facility, or at home

  • Diagnostic and lab tests done outside hospitals and nursing facilities

  • Preventive services such as flu shots, mammograms, screenings for depression and diabetes, and so on, many of which are free

  • Some medical equipment and supplies (for example, wheelchairs, walkers, oxygen, diabetic supplies, and units of blood)

  • Some outpatient hospital treatment received in an emergency room, clinic, or ambulatory surgical unit

  • Some inpatient care in cases where patients are placed under observation in the hospital instead of being formally admitted

  • Inpatient prescription drugs given in a hospital or doctor’s office, usually by injection (such as chemotherapy drugs for cancer)

  • Some coverage for physical, occupational, and speech therapies

  • Outpatient mental health care

  • Second opinions for non-emergency surgery in some circumstances

  • Approved home health services not covered by Part A

  • Ambulance or air rescue service in circumstances where any other kind of transportation would endanger the patient’s health

  • Free counseling to help curb obesity, smoking, or alcohol abuse

You must pay a monthly premium to receive Part B services unless your income is low enough to qualify you for assistance from your state. Most people pay the standard Part B premium, which is determined each year by a formula set by law ($104.90 per month in 2013). If your income is over a certain level, however, you’re required to pay more

You also pay a share of the cost of most Part B services. In traditional Medicare, this amount is almost always 20 percent of the Medicare-approved cost. Medicare Advantage health plans charge different amounts — usually flat dollar co-pays for each service.

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