Medicare Part B is medical insurance that helps pay for medical expenses relating to your doctors’ services, also known as outpatient expenses. While most Americans will receive Part A without paying a premium, Part B is optional and enrollees must pay a monthly premium for the coverage. Enrollment in Part B is necessary, however, if you would like to enroll in additional optional benefits, such as prescription drug plans (Part D), Medigap plans, or Medicare Advantage plans.
Cost
You will pay a monthly premium for your Medicare Part B coverage. When you use services you will also pay a deductible and coinsurance.
In 2010, people with higher incomes will pay higher premiums for Part B. Approximately 4 percent of Medicare Part B enrollees will pay a higher Part B premium based on their income. Higher-income people will pay even more. Most people will continue to pay the 2009 Part B premium of $96.40 in 2010. If you have questions about your Part B premium, call Social Security at 1 800 772 1213. TTY users should call 1 800 325 0778.
| If your yearly income in 2009 was: | Your 2010 Part B premium is: | |
|---|---|---|
| Individual Tax Return | Joint Tax Return | |
| $85,000 or below | $170,000 or below | $110.50 |
| $85,001 - $107,000 | $170,001–$214,000 | $154.70 |
| $107,001–$160,000 | $214,001–$320,000 | $221.00 |
| $160,001–$214,000 | $320,001–$428,000 | $287.30 |
| $240,000 or above | above $428,000 | $353.60 |
In 2010, if you use Part B-covered services, you will pay a deductible. The deductible is the same for all people with Part B coverage. After paying the deductible, you will pay coinsurance of 20% of the Medicare-allowed payment to the Part B health care provider. The 2010 Part B deductible is $155.
Part B-Covered Services
There are two kinds of Part B-covered services:
Medically-necessary services—Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.
Preventive services-Health care to prevent illness or detect it at an early stage, when treatment is most likely to work best (for example, Pap tests, flu shots, and colorectal cancer screenings).
Abdominal Aortic Aneurysm Screening
A one-time screening ultrasound for people at risk. Medicare only covers this screening
if you get a referral for it as a result of your one-time “Welcome to Medicare”
physical exam. You pay 20% of the Medicare approved amount.
Ambulance Services
Emergency ground transportation when you need to be transported to a hospital or
skilled nursing facility for medically necessary services, and transportation in
any other vehicle could endanger your health. Medicare will pay for transportation
in an airplane or helicopter if you require immediate and rapid ambulance transportation
that ground transportation can’t provide.
In some cases, Medicare may pay for limited non-emergency transportation if you
have orders from your doctor. Medicare will only cover services to the nearest appropriate
medical facility that is able to give you the care you need. You pay 20% of the
Medicare-approved amount, and the Part B deductible applies.
Ambulatory Surgical Centers
Facility fees for approved surgical procedures provided in an Ambulatory Surgical
Center (facility where surgical procedures are performed, and the patient is released
within 24 hours). You pay 20% of the Medicare-approved amount (except for screening
flexible sigmoidoscopies and screening colonoscopies, for which you pay 25%), and
the Part B deductible applies. You pay all facility charges for procedures Medicare
doesn’t allow in ambulatory surgical centers.
Blood
In most cases, the provider gets blood from a blood bank at no charge, and you won’t
have to pay for it or replace it. However, you will pay a copayment for the blood
processing and handling services for every unit of blood you get, and the Part B
deductible applies. If the provider has to buy blood for you, you must either pay
the provider costs for the first 3 units of blood you get in a calendar year or
have the blood donated by you or someone else.
You pay a copayment for additional units of blood you get as an outpatient (after
the first 3), and the Part B deductible applies.
Bone Mass Measurement(Bone Density)
Helps to see if you are at risk for broken bones. This service is covered once every
24 months (more often if medically necessary) for people who have certain medical
conditions or meet certain criteria. You pay 20% of the Medicare approved amount,
and the Part B deductible applies.
Cardiovascular Screenings
Helps detect conditions that may lead to a heart attack or stroke. This service
is covered every 5 years to test your cholesterol, lipid, and triglyceride levels.
No cost for the test, but you generally have to pay 20% of the Medicare approved
amount for the doctor’s visit.
Chiropractic Services (limited)
Helps correct a subluxation (when one or more of the bones of your spine move out
of position) using manipulation of the spine. You pay 20% of the Medicare-approved
amount, and the Part B deductible applies.
Clinical Laboratory Services
Includes certain blood tests, urinalysis, some screening tests, and more. No cost
to you.
Clinical Research Studies
Clinical research studies test different types of medical care, like how well a
cancer drug works. They help doctors and researchers see if the new care works and
if it’s safe. Medicare covers some costs, like doctor visits and tests, in qualifying
clinical research studies. You pay 20% of the Medicare-approved amount, and the
Part B deductible applies.
Colorectal Cancer Screenings
To help find precancerous growths and help prevent or find cancer early, when treatment
is most effective. One or more of the following tests may be covered. Talk to your
doctor.
Fecal Occult Blood Test—Once every 12 months if age 50 or older. No cost for the
test, but you generally have to pay 20% of the Medicare-approved amount for the
doctor’s visit.
Flexible Sigmoidoscopy—Generally, once every 48 months if age 50 or older, or 120
months after a previous screening colonoscopy for those not at high risk. You pay
20% of the Medicare-approved amount.
Colonoscopy—Generally once every 120 months (high risk every 24 months) or 48 months
after a previous flexible sigmoidoscopy. No minimum age. You pay 20% of the Medicare-approved
amount.
Barium Enema—Once every 48 months if age 50 or older (high risk every 24 months)
when used instead of a sigmoidoscopy or colonoscopy. You pay 20% of the Medicare-approved
amount.
Note: If you get a screening flexible sigmoidoscopy or screening colonoscopy in
an outpatient hospital setting or an ambulatory surgical center, you pay 25% of
the Medicare-approved amount.
Defibrillator (Implantable Automatic)
For some people diagnosed with heart failure. You pay 20% of the Medicare-approved
amount for the doctor’s services. You pay a copayment but no more than the Part
A hospital stay deductible if you get the device as a hospital outpatient. The Part
B deductible applies.
Diabetes Screenings
Checks for diabetes. These screenings are covered if you have any of the following
risk factors: high blood pressure (hypertension), history of abnormal cholesterol
and triglyceride levels (dyslipidemia), obesity, or a history of high blood sugar
(glucose). Tests are also covered if you answer yes to two or more of the following
questions:
Are you age 65 or older?
Are you overweight?
Do you have a family history of diabetes (parents, siblings)?
Do you have a history of gestational diabetes (diabetes during pregnancy), or did
you deliver a baby weighing more than 9 pounds?
Based on the results of these tests, you may be eligible for up to two diabetes
screenings every year. No cost for the test, but you generally have to pay 20% of
the Medicare-approved amount for the doctor’s visit.
Diabetes Self Management Training
For people with diabetes. Your doctor or other health care provider must provide
a written order. You pay 20% of the Medicare-approved amount, and the Part B deductible
applies.
Diabetes Supplies
Including blood sugar testing monitors, blood sugar test strips, lancet devices
and lancets, blood sugar control solutions, and therapeutic shoes (in some cases).
Insulin is covered only if used with an insulin pump. You pay 20% of the Medicare-approved
amount, and the Part B deductible applies.
Note: Insulin and certain medical supplies used to inject insulin, such as syringes,
may be covered by Medicare prescription drug coverage (Part D).
Doctor Services
Services that are medically necessary (includes outpatient and some doctor services
you get when you are a hospital inpatient) or covered preventive services. Doesn’t
cover routine physicals except for the one-time “Welcome to Medicare” physical exam.
You pay 20% of the Medicare-approved amount, and the Part B deductible applies.
Durable Medical Equipment (like walkers)
Items such as oxygen equipment and supplies, wheelchairs, walkers, and hospital
beds your doctor orders for use in the home. You pay 20% of the Medicare-approved
amount, and the Part B deductible applies. You must get your covered equipment or
supplies from a supplier enrolled in Medicare. You should also check if the supplier
is a participating supplier. Participating suppliers must accept assignment, and
your out of pocket costs may be less.
EKG Screening
Medicare covers a one-time screening EKG if you get a referral for it as a result
of your one-time “Welcome to Medicare” physical exam. You pay 20% of the Medicare-approved
amount, and the Part B deductible applies. An EKG is also covered as a diagnostic
test.
Emergency Room Services
When you believe your health is in serious danger. You may have a bad injury, a
sudden illness, or an illness that quickly gets much worse. You pay a specified
copayment for the hospital emergency department visit, and you pay 20% of the Medicare-approved
amount for the doctor’s services. The Part B deductible applies.
Eye Exams for People with Diabetes
Checks for diabetic retinopathy once every 12 months by an eye doctor who is legally
allowed by the state to do the test. You pay 20% of the Medicare-approved amount,
and the Part B deductible applies.
Eyeglasses (limited)
One pair of eyeglasses with standard frames (or one set of contact lenses) after
cataract surgery that implants an intraocular lens. You pay 20% of the Medicare-approved
amount, and the Part B deductible applies.
Federally-Qualified Health Center Services
Includes many outpatient primary care and preventive services you get through certain
community-based organizations. You pay 20% of the Medicare-approved amount.
Flu Shots
Helps prevent influenza or flu virus. Covered once a flu season in the fall or winter.
You need a flu shot for the current virus each year. No cost to you for the flu
shot if the doctor accepts assignment for giving the shot.
Foot Exams and Treatment
If you have diabetes-related nerve damage and/or meet certain conditions. You pay
20% of the Medicare-approved amount, and the Part B deductible applies.
Glaucoma Tests
Helps find the eye disease glaucoma. Covered once every 12 months for people at
high risk for glaucoma. You are considered high risk for glaucoma if you have diabetes,
a family history of glaucoma, are African-American and age 50 or older, or are Hispanic
and age 65 or older. An eye doctor who is legally authorized by the state must do
the tests. You pay 20% of the Medicare-approved amount, and the Part B deductible
applies.
Hearing and Balance Exams
If your doctor orders it to see if you need medical treatment. You pay 20% of the
Medicare-approved amount, and the Part B deductible applies.
Note: Medicare doesn’t cover hearing aids and exams for fitting hearing aids.
Hepatitis B Shots
Helps protect people from getting Hepatitis B. This is covered for people at high
or medium risk for Hepatitis B. Your risk for Hepatitis B increases if you have
hemophilia, End Stage Renal Disease (ESRD), or a condition that increases your risk
for infection. Other factors may increase your risk for Hepatitis B, so check with
your doctor. You pay 20% of the Medicare approved amount, and the Part B deductible
applies.
Home Health Services
Limited to medically-necessary part-time or intermittent skilled nursing care, or
physical therapy, speech-language pathology, or a continuing need for occupational
therapy. A doctor must order it, and a Medicare-certified home health agency must
provide it. Home health services may also include medical social services, part-time
or intermittent home health aide services, durable medical equipment, and medical
supplies for use at home. You must be homebound, which means that leaving home is
a major effort. No cost to you for home health services. For Medicare-covered durable
medical equipment, you pay 20% of the Medicare approved amount, and the Part B deductible
applies.
Kidney Dialysis Services and Supplies
For people with End-Stage Renal Disease (ESRD). Medicare covers dialysis either
in a facility or at home when your doctor orders it. You pay 20% of the Medicare-approved
amount, and the Part B deductible applies.
Kidney Disease Education Services
Medicare may cover kidney disease education services if you have kidney disease,
and your doctor refers you for the service. You pay 20% of the Medicare-approved
amount, and the Part B deductible applies.
Mammograms (screening)
A type of X-ray to check women for breast cancer before they or their doctor may
be able to find it. Medicare covers screening mammograms once every 12 months for
all women with Medicare age 40 and older. Medicare covers one baseline mammogram
for women between ages 35–39. You pay 20% of the Medicare-approved amount.
Medical Nutrition Therapy Services
Medicare may cover medical nutrition therapy and certain related services if you
have diabetes or kidney disease, or you have had a kidney transplant in the last
36 months, and your doctor refers you for the service. You pay 20% of the Medicare-approved
amount, and the Part B deductible applies.
Mental Health Care (outpatient)
To get help with mental health conditions such as depression, anxiety, or substance
abuse. Includes services generally given outside a hospital or in a hospital outpatient
department, including visits with a doctor, psychiatrist, clinical psychologist,
or clinical social worker, and lab tests. Certain limits and conditions apply.
What you pay will depend on whether you are being diagnosed and monitored or whether
you are getting treatment.
For visits to a doctor or other health care provider to diagnose your condition,
or to monitor or change your prescriptions, you pay 20% of the Medicare-approved
amount.
For outpatient treatment of your condition (such as counseling or psychotherapy),
you pay 45% in 2010 (which is lower than in 2009) of the Medicare-approved amount.
This copayment amount will continue to decrease over the next 4 years.
The Part B deductible applies for both visits to diagnose or monitor your condition
as well as treatment.
Note: Inpatient mental health care is covered under Part A hospital stays.
Talk to your doctor if you feel sad, have little interest in things you used to
enjoy, feel dependent on drugs or alcohol, or have thoughts about ending your life.
Non-doctor Services
Medicare covers services provided by non-doctors, such as physician assistants and
nurse practitioners. You pay 20% of the Medicare-approved amount, and the Part B
deductible applies.
Occupational Therapy
Evaluation and treatment to help you return to usual activities (such as dressing
or bathing) after an illness or accident when your doctor certifies you need it.
There may be limits on physical therapy, occupational therapy, and speech-language
pathology services and exceptions to these limits. You pay 20% of the Medicare-approved
amount, and the Part B deductible applies.
Outpatient Hospital Services
Services you get as an outpatient as part of a doctor’s care. You may pay more for
a doctor’s care in an outpatient department of a hospital than you will pay for
the same care in a doctor’s office. You pay a specified copayment for each service.
The copayment can’t be more than the Part A hospital stay deductible. The Part B
deductible applies.
Outpatient Medical and Surgical Services and Supplies
For approved procedures (like X-rays, a cast, or stitches). You pay a copayment
for each service you get in an outpatient hospital setting. For each service, this
amount can’t be more than the Part A hospital stay deductible. The Part B deductible
applies, and you pay all charges for items or services that Medicare doesn’t cover.
Pap Tests and Pelvic Exams (includes clinical breast exam)
Checks for cervical, vaginal, and breast cancers. Medicare covers these screening
tests once every 24 months, or once every 12 months for women at high risk, and
for women of child-bearing age who have had an exam that indicated cancer or other
abnormalities in the past 3 years. No cost to you for the Pap lab test. You pay
20% of the Medicare-approved amount for Pap test specimen collection, and pelvic
and breast exams.
Physical Exam (one-time “Welcome to Medicare” physical exam)
A one-time review of your health, and education and counseling about preventive
services, including certain screenings, shots, and referrals for other care if needed.
Medicare will cover this exam if you get it within the first 12 months you have
Part B. You pay 20% of the Medicare-approved amount. When you make your appointment,
let your doctor’s office know that you would like to schedule your “Welcome to Medicare”
physical exam.
Physical Therapy
Evaluation and treatment for injuries and diseases that change your ability to function
when your doctor certifies your need for it. There may be limits on these services
and exceptions to these limits. You pay 20% of the Medicare-approved amount, and
the Part B deductible applies.
Pneumococcal Shot
Helps prevent pneumococcal infections (like certain types of pneumonia). Most people
only need this preventive shot once in their lifetime. Talk with your doctor. No
cost if the doctor or supplier accepts assignment for giving the shot.
Prescription Drugs (limited)
Includes a limited number of drugs such as injections you get in a doctor’s office,
certain oral cancer drugs, drugs used with some types of durable medical equipment
(like a nebulizer or infusion pump) and under very limited circumstances, certain
drugs you get in a hospital outpatient department. You pay 20% of the Medicare-approved
amount for these covered drugs. If the covered drugs you get in a hospital outpatient
department are part of the service you get, you pay the copayment for the services.
However, if you get other types of drugs in a hospital outpatient department, what
you pay depends on whether you have Part D or other prescription drug coverage,
whether the drug is covered by your drug plan, and whether the hospital is in your
drug plan’s network. Contact your prescription drug plan to find out what you pay
for drugs you get in a hospital outpatient department. Keep in mind that under Part
B, you pay 100% for most prescription drugs, unless you have Part D or other drug
coverage.
Prostate Cancer Screenings
Helps detect prostate cancer. Medicare covers a digital rectal exam and Prostate
Specific Antigen (PSA) test once every 12 months for all men with Medicare over
age 50. You pay 20% of the Medicare approved amount, and the Part B deductible applies
for the doctor’s visit. You pay nothing for the PSA test.
Prosthetic/ Orthotic Items
Including arm, leg, back, and neck braces; artificial eyes; artificial limbs (and
their replacement parts); some types of breast prostheses (after mastectomy); and
prosthetic devices needed to replace an internal body part or function (including
ostomy supplies, and parenteral and enteral nutrition therapy) when your doctor
orders it. For Medicare to cover your prosthetic or orthotic, you must go to a supplier
that is enrolled in Medicare. You pay 20% of the Medicare-approved amount, and the
Part B deductible applies.
Rural Health Clinic Services
Includes many outpatient primary care services. You pay 20% of the amount charged,
and the Part B deductible applies.
Second Surgical Opinions
Covered in some cases for surgery that isn’t an emergency. In some cases, Medicare
covers third surgical opinions. You pay 20% of the Medicare-approved amount, and
the Part B deductible applies.
Smoking Cessation (counseling to stop smoking)
Includes up to 8 face-to-face visits in a 12-month period if you are diagnosed with
an illness caused or complicated by tobacco use, or you take a medicine that is
affected by tobacco. You pay 20% of the Medicare-approved amount, and the Part B
deductible applies.
Speech-Language Pathology Services
Evaluation and treatment given to regain and strengthen speech and language skills
including cognitive and swallowing skills when your doctor certifies your need for
it. There may be limits on these services and exceptions to these limits. You pay
20% of the Medicare-approved amount, and the Part B deductible applies.
Surgical Dressing Services
For treatment of a surgical or surgically-treated wound. You pay 20% of the Medicare-approved
amount for doctor services. You pay a fixed copayment for these services when you
get them in a hospital outpatient department. You pay nothing for the supplies.
The Part B deductible applies.
Telehealth
Includes a limited number of medical or other health services, like office visits
and consultations provided using an interactive two-way telecommunications system
(like real-time audio and video) by an eligible provider who is at a location different
from the patient’s. Available in some rural areas, under certain conditions, and
only if the patient is located at one of the following places: a doctor’s office,
hospital, rural health clinic, federally-qualified health center, hospital-based
dialysis facility, skilled nursing facility, or community mental health center.
You pay 20% of the Medicare-approved amount, and the Part B deductible applies.
Tests
Including X-rays, MRIs, CT scans, EKGs, and some other diagnostic tests. You pay
20% of the Medicare-approved amount, and the Part B deductible applies. If you get
the test at a hospital as an outpatient, you pay a specified copayment that may
be more than 20% of the Medicare-approved amount, but it can’t be more than the
Part A hospital stay deductible.
Transplants and Immunosuppressive Drugs
Including doctor services for heart, lung, kidney, pancreas, intestine, and liver
transplants under certain conditions and only in a Medicare-certified facility.
Medicare covers bone marrow and cornea transplants under certain conditions.
Immunosuppressive drugs are covered if Medicare paid for the transplant, or an employer
or union group health plan that was required to pay before Medicare paid for the
transplant. You must have been entitled to Part A at the time of the transplant,
and you must be entitled to Part B at the time you get immunosuppressive drugs.
You pay 20% of the Medicare-approved amount, and the Part B deductible applies.
If you are thinking about joining a Medicare Advantage Plan and are on a transplant
waiting list or believe you need a transplant, check with the plan before you join
to make sure your doctors and hospitals are in the plan’s network. Also, check the
plan’s coverage rules for prior authorization.
Note: Medicare drug plans (Part D) may cover immunosuppressive drugs, even if Medicare
or an employer or union group health plan didn’t pay for the transplant.
Travel (health care needed when traveling outside the United States) (limited)
Medicare generally doesn’t cover health care while you are traveling outside the
U.S. (the “U.S.” includes the 50 states, the District of Columbia, Puerto Rico,
the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa). There
are some exceptions including some cases where Medicare may pay for services that
you get while on board a ship within the territorial waters adjoining the land areas
of the U.S. In rare cases, Medicare may pay for inpatient hospital, doctor, or ambulance
services you get in a foreign country in the following situations:
1) If an emergency arose within the U.S. and the foreign hospital is closer than
the nearest U.S. hospital that can treat your medical condition
2) If you are traveling through Canada without unreasonable delay by the most direct
route between Alaska and another state when a medical emergency occurs and the Canadian
hospital is closer than the nearest U.S. hospital that can treat the emergency
3) If you live in the U.S. and the foreign hospital is closer to your home than
the nearest U.S. hospital that can treat your medical condition, regardless of whether
an emergency exists
You pay 20% of the Medicare-approved amount, and the Part B deductible applies.
Urgently-Needed Care
To treat a sudden illness or injury that isn’t a medical emergency. You pay 20%
of the Medicare-approved amount, and the Part B deductible applies.
For more specific information on these services, here is an overview from the Center for Medicare Services.
Home Healthcare
If you need clinical laboratory services, Medicare Part B will pay for:
- Blood tests
- Urinalysis
- Some screening tests
If you need home health care, Medicare Part B will pay for:
- Reasonable and necessary part-time or intermittent skilled nursing care and home health aide services
- Physical therapy, occupational therapy, and speech-language pathology that are ordered by your doctor and provided by a Medicare-certified home health agency
- Medical social services, such as getting professional help in arranging needed follow-up care by referral to health-care resources
- Durable medical equipment and other medical supplies (such as wheelchairs, hospital beds, oxygen, and walkers)
If you need outpatient hospital services, Medicare Part B will pay for:
- Hospital services and supplies received as an outpatient as prescribed by your doctor
