Medicare Part B: Coverage Outside of a Hospital

Medicare Part B is federal health insurance for the medical needs of people 65 and older and individuals with certain qualifying disabilities.

Generally encompassing outpatient medical care, Part B coverage includes medically necessary doctor’s services, preventive care, and other specific services.

When Do I Sign Up for Medicare Part B?

It depends. You become eligible for Medicare at age 65. If you are currently receiving Social Security benefits, you will be enrolled automatically in Medicare Parts A and B.

If you are still working and have an employer or union group health insurance plan, it is possible you will not need to sign up for Medicare Part B right away. Be sure to talk to your employer.

If you do not have an employer or union group health insurance plan, or that plan is secondary to Medicare, avoid delaying enrollment in Medicare Part B. If you fail to enroll during your initial enrollment period, you may face a permanent penalty.

Learn more on ElderLawAnswers.com about what you need to know regarding Medicare enrollment.

2023 Premiums, Hospital Deductible, and Coinsurance Amounts

Part B enrollees pay a monthly premium that is adjusted annually. For 2023, the base monthly premium for Medicare Part B is $164.90. The premium then increases as the beneficiary’s individual or joint income increases.

The yearly deductible for all Medicare Part B beneficiaries is $226. Beneficiaries must pay all costs until they meet the deductible. After that, Medicare covers most of the remaining fees, while the enrollee generally pays about 20 percent of the Medicare-approved amount of the service.

Medicare does not set a limit on what individuals contribute. The amount people can pay for Medicare in 2023 depends on the medical services they receive.

Most preventive services, however, may be entirely covered when beneficiaries receive these services from providers who accept Medicare. Enrollees may need to pay coinsurance or a deductible for select services and services received while getting non-preventive care.

Treatments Covered

From surgeries to mental health treatment, Part B covers many types of medical services. These include the following:

• Surgeries, such as bariatric surgery, as well as fees related to surgery in outpatient facilities, second surgical opinions, and surgical dressing services
• Cancer treatment, such as chemotherapy
• Acupuncture for chronic back pain and chiropractic services
• Behavioral health treatment for mental health conditions like depression and anxiety, and occupational therapy
• Cardiac rehabilitation if an individual suffers a cardiac event
• Cognitive assessments and care plan services for dementia
• Emergency treatment for injury, sudden illness, or illness that quickly worsens
• Care for such medically necessary treatments as:
  • sleep apnea
  • diabetes
  • foot care
  • hearing and balance exams
  • kidney disease treatment
  • medical supplies and services
  • services to manage chronic conditions
  • prosthetics
  • lab tests
  • diagnostic tests
  • COVID tests
  • transplants and immunosuppressive drugs

Preventative Care

Preventative care helps people stay healthy and avoid disease. Medicare Part B’s coverage encompasses many types of preventative care, such as vaccines, disease screenings, and mental health care.

• The insurance includes an initial Welcome to Medicare health visit and a yearly wellness visit.
• The costs of vaccinations, booster shots, and additional doses are entirely taken care of, such as shots for the flu, Hepatitis B, COVID-19, and pneumonia.
• The program covers preventative care and screenings for mental health and substance use. Beneficiaries can receive one depression screening per year for no additional cost. They can also have counseling sessions about tobacco use and an alcohol misuse screening.
• Part B covers screenings for certain diseases. Patients can receive screenings for being at risk for breaking bones, diabetes, cardiovascular disease, abdominal aortic aneurysms, Human Immunodeficiency Virus, and sexually transmitted infections. Colorectal, lung, breast, and prostate cancer screenings are available as well.
• Services related to weight management, such as nutrition therapy and obesity behavioral treatment, are also available.

Other Services Related to Medical Care

In addition to outpatient medical treatments, Medicare Part B covers other services such as transportation to the hospital, help with advanced care planning, and telehealth visits.

• When individuals need transportation to access medically necessary services, Part B covers ground transportation ambulance services to hospitals, critical access hospitals, and skilled nursing facilities.
• As part of the yearly wellness visit, individuals can get help with advance care planning, which includes support in creating an advance directive. If you become incapacitated in the future, this legal document states your wishes for medical treatment.
• Medicare enrollees can use telehealth visits to have medical appointments via technology rather than visiting a physical office.
• Those who undergo cataract surgery that implants an intraocular lens can get one pair of eyeglasses covered.
• Part B or Part A can cover home health services.

Additional Resources

• Find out what you need to know in order to sign up for Medicare.
• Read about Part B’s covered services in Medicare’s handbook (PDF format).
• Learn more about Medicare Part A, Part C, and Part D.
• Learn more about what Medicare Part B entails, consult an elder law attorney near you.

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