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Medicare Part B Coverage

Medicare Part B coverage includes medical services and supplies that are considered “medically necessary” to treat a disease or condition. Regardless of what type of Medicare coverage a beneficiary has elected to have, whether through Medicare Advantage or Original Medicare, all plans must generally cover the same benefits.  Some types of equipment or services may only be covered in specific circumstances or for patients with certain medical conditions.

Part B covers preventative care services with no copay.  These preventative services include a yearly “wellness” check-up with a doctor, a flu shot, mammograms and pap smears, prostate cancer screenings, bone density measurements, and screenings for diabetes, depression, HIV, and several other illnesses.  Medicare limits how frequently these preventative screenings can take place, whether it is once a year or bi-annually.

Part B will cover 80% of medically necessary doctors’ services needed to treat or diagnose a medical condition according to the normal standards of medical care.  It will also cover things like durable medical equipment (including diabetic supplies and CPAP machines for sleep apnea), ambulance services, mental health care, clinical research, getting a second opinion prior to surgery, and some limited prescription medications (for example, chemotherapy drugs).  The remaining 20% is paid by the patient.

Typically, if a doctor is concerned that a patient’s care will not be covered by Medicare, they must notify the patient in writing and have them sign a document stating that they may be responsible for the cost.  This may occur if the patient requests or requires treatment that is experimental or has not yet been approved for their medical condition.  Keep in mind that Medicare will not ever pay for care that is not medically necessary, like cosmetic surgery, or care that is received in a foreign country.

We put together a chart to help you understand Medicare Part B Coverage (and Part A).

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