Jeffrey Wade
Medicare Part B is an optional, medically necessary insurance plan that covers outpatient care, doctor's services, and preventive services. It is available to people 65 and over, and those under 65 with a disability or specific health condition. Part B is often bundled with Part A and Part D, which covers prescription drugs, and is offered by private companies as an alternative to Original Medicare.
| Characteristics | Values |
|---|---|
| Services covered | Medically necessary services, preventive services |
| Medically necessary services include | Services or supplies that meet accepted standards of medical practice to diagnose or treat your medical condition |
| Preventive services include | Health care to prevent illness (like the flu) or detect it at an early stage when treatment is likely to work best, exams, lab tests, screening shots |
| Other services covered | Doctors' services, outpatient care |
| Cost | $185 per month in 2025 |
| Insulin benefit | If you use an insulin pump covered under Part B, your cost for a month's supply of insulin for your pump can't be more than $35 |
| Not covered | Nursing home care, dental care, routine eye exams, hearing aids, care while traveling abroad, cosmetic surgery |
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What You'll Learn
Doctors' services
Medicare Part B covers medically necessary doctors' services and outpatient care, as well as preventive services. This includes doctor's office visits, scans, and tests. It also covers some prescription drugs, but not those you can get at a pharmacy. For example, it covers inpatient medicine, like a flu vaccine from your primary care physician.
Medicare Part B helps to pay for covered medical services and items when they are deemed medically necessary. This includes services and supplies that meet accepted standards of medical practice to diagnose or treat a medical condition. It also covers preventive services, such as healthcare to prevent illness or detect it in its early stages.
If you have Part B, you will pay a premium each month. Most people will pay the standard premium amount, which in 2025 is $185 per month. If you don't sign up for Part B when you are first eligible, you may have to pay a late enrollment penalty.
It's important to note that not all providers accept Medicare as full payment. Medicare classifies healthcare providers in three ways:
- Participating: They accept Medicare and Medicare-approved payment for services.
- Non-participating: They accept Medicare but may charge more than the Medicare-approved payment for services.
- Opt-out: They don't accept Medicare at all, and patients are responsible for all costs for care, except for emergency care or urgently needed care.
If your doctor accepts the amount Medicare agrees to pay for the service, your costs are limited to the 20% coinsurance. However, some providers who charge more than the Medicare-assigned amount may bill patients for the difference. In this case, you may be responsible for paying a portion of the difference between Medicare's reimbursement rate and the provider's actual charge.
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Outpatient care
Medicare Part B covers a wide range of medically necessary outpatient services. It covers 80% of Medicare-approved services, leaving you responsible for the remaining 20%.
Part B covers preventive care, including flu shots, colonoscopies, mammograms, and more. It also covers ordinary outpatient services like doctor's visits, lab testing, home health care, ambulance rides, and some chiropractic care. It covers outpatient hospital care, such as emergency room services and some same-day surgical procedures.
Medicare Part B also covers some prescription medications, such as those administered intravenously or by a physician. It covers vaccines for the flu, pneumonia, COVID-19, and hepatitis B (if you're at medium or high risk). It also covers some oral cancer drugs and medicines used with durable medical equipment, like nebulizer medications.
Part B does not cover drugs that you pick up at a retail pharmacy. For those, you will need a Part D drug plan. It also does not cover cosmetic procedures, routine dental, vision or hearing, or routine foot care.
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Preventative services
Medicare Part B (Medical Insurance) covers preventive services, which are types of healthcare that aim to prevent illnesses (e.g., the flu) or detect them at an early stage when treatment is most likely to be successful. Most preventive services are free if you receive them from a healthcare provider who accepts assignment.
Medicare Part B covers 100% of the Medicare-approved amount for certain preventive screening examinations that are appropriately prescribed by a physician. These screenings must be carried out by a participating provider. For example, Medicare Part B covers colorectal cancer screenings, including fecal occult blood tests, sigmoidoscopies, and colonoscopies, at certain intervals.
It's important to note that if you have a Medicare Advantage Plan or another Medicare plan, the coverage rules may differ. However, your plan must provide at least the same coverage as Original Medicare. Original Medicare includes Medicare Part A (Hospital Insurance) and Medicare Part B, and it covers preventive services, doctors' services and tests, and inpatient hospital care.
Medicare Part B typically pays 80% of the approved charges for medical services, and you are responsible for the remaining 20%, known as the coinsurance amount. Before Medicare pays anything under Part B, you must also pay a deductible amount of your covered medical bills for the year, which is $240 for 2024.
If you have Medicare Part B and Medicare Supplement Insurance (Medigap), your Medigap plan may cover the cost of insulin, which is $35 or less.
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Medically necessary services
Medicare Part B covers medically necessary services, which include outpatient care such as doctor's office visits, scans, tests, and other services that Part A does not cover. These services or supplies must meet accepted standards of medical practice to diagnose or treat a medical condition. For example, if you require an insulin pump, Part B's durable medical equipment benefit will cover it.
It is important to note that Medicare Part B is optional, and there is a monthly premium associated with it. Most people will pay the standard premium amount, which was $185 per month in 2025. Signing up for Part B when you become eligible for Medicare is crucial to avoid late enrollment penalties.
Additionally, while Part B covers many medically necessary services, there are some exclusions. Services such as nursing home care, routine eye exams (unless for specific conditions), dental care, dentures, hearing aids, and cosmetic surgery are generally not covered. Furthermore, care received while traveling abroad is typically not covered by Part B, although there may be rare exceptions or alternative coverage options, such as through a Medicare Advantage Plan or a Medicare Supplement Plan.
Medicare Advantage Plans, offered by private companies, provide an alternative to Original Medicare and typically include Part A, Part B, and sometimes Part D (prescription drug coverage). These plans may offer different out-of-pocket costs and additional benefits compared to Original Medicare.
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Insulin pump coverage
Insulin pumps are medical devices that supply a constant, small amount of insulin to people with diabetes to maintain their target blood sugar levels. Medicare Part B may cover insulin pumps as medically necessary durable medical equipment (DME). However, this coverage is subject to certain conditions.
Firstly, Medicare Part B covers diabetes-related services and supplies, including insulin pumps and insulin, under its medically necessary services category. This means that the pump must be deemed medically necessary by a healthcare professional for an individual's specific condition. To access this coverage, individuals typically need a referral from their doctor.
Secondly, the coverage of insulin pumps under Medicare Part B may depend on the individual's location within the country. In certain areas, Medicare may only cover the cost of a durable insulin pump if it is sourced from specific suppliers. Therefore, it is important for individuals to verify the approved suppliers in their region before acquiring an insulin pump.
Additionally, Medicare Advantage plans, also known as Medicare Part C or MA plans, are provided by private insurance companies that are contractually Medicare-approved. These plans include the standard Medicare Part B coverage and may cover medically necessary insulin pumps. However, individuals with Medicare Advantage plans should contact their private insurance company to understand the specific details of their coverage and benefits.
It is worth noting that Medicare Part D, which covers prescription drugs, may also provide coverage for diabetes-related supplies, including insulin and antidiabetic drugs. However, this part of Medicare specifically applies to individuals who do not use an insulin infusion pump.
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Frequently asked questions
Medicare Part B is a federal health insurance plan that covers medically necessary services and preventive services.
Part B medical insurance covers medically necessary outpatient services, such as doctor's office visits, scans, tests, and preventive care.
Most people pay a standard premium of $185 per month in 2025.
You should sign up for Medicare Part B when you first become eligible during your initial enrollment period to avoid late enrollment penalties.
Medicare Part B does not cover nursing home care, routine eye exams, dental care, hearing aids, cosmetic surgery, and care while traveling abroad, unless under rare circumstances.
