Alyssa Lane
Medicare Part B, also known as Medical Insurance, is one of the two parts of Original Medicare, the other being Part A, or Hospital Insurance. Part B covers medically necessary services, such as outpatient care, doctor's visits, scans and tests, and preventive care, as well as medical items like diabetic test strips, nebulizers, and wheelchairs. It is available to people aged 65 or older, as well as those with disabilities, end-stage renal disease, or ALS. Most people pay a premium of $185 per month for Part B, and it is important to sign up as soon as one becomes eligible to avoid late enrollment penalties. Additionally, Medicare Supplement Insurance, or Medigap, can be purchased to help cover out-of-pocket costs associated with Part B.
| Characteristics | Values |
|---|---|
| Type of Insurance | Medical Insurance |
| Part of | Original Medicare |
| Coverage | Medically necessary services, Preventive services, Doctor's office visits, Scans and tests, Diabetic test strips, Nebulizers, Wheelchairs |
| Cost | $185 per month (in 2025) |
| Late Enrollment Penalty | 10% above the standard premium cost for every 12-month period delayed |
| Insulin Benefit | Cost for a month's supply of insulin cannot be more than $35 |
| Eligibility | People 65 and older, People under 65 with a disability or specific health condition |
| Enrollment | Automatic for those who have received Social Security disability benefits for 24 months |
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What You'll Learn
Medically necessary services
Medicare Part B is a form of medical insurance that helps cover medically necessary services and preventive services. Medically necessary services are services or supplies that meet accepted standards of medical practice to diagnose or treat a medical condition.
Medicare Part B covers medically necessary outpatient services, such as doctor's office visits, scans, and tests. These services must adhere to accepted medical standards and practices to be eligible for coverage under Part B.
Medicare-approved private companies offer plans with varying rules for accessing services, such as requiring referrals for specialists. Costs for monthly premiums and services can vary depending on the chosen plan. However, all plans must cover emergency and urgent care, as well as almost all medically necessary services covered by Original Medicare.
Some plans may offer additional benefits tailored to specific conditions, ensuring comprehensive coverage for enrollees. It is important to note that individuals receiving healthcare continuation coverage under COBRA still need to sign up for Part B to avoid penalties.
Medicare Part B is designed to provide essential coverage for individuals 65 and older, as well as those under 65 with disabilities or specific health conditions. By offering coverage for medically necessary services, Part B helps ensure that individuals can access the outpatient care they need to manage their health effectively.
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Preventive services
Medicare Part B (Medical Insurance) covers two types of services: medically necessary services and preventive services. Preventive services are defined as healthcare to prevent illness or detect it at an early stage when treatment is most likely to be effective. For instance, preventing the flu or detecting it early on.
Some examples of preventive services that may be covered under Medicare Part B include screenings, tests, and scans. These services can help detect health issues early on, allowing for timely treatment and potentially improving health outcomes. It is important to note that the specific preventive services covered may vary, and not all preventive care services may be included.
Medicare Part B is available to individuals 65 and older, as well as those under 65 with a disability or specific health condition. It is important to sign up for Part B when becoming eligible for Medicare to avoid late enrollment penalties. The standard premium cost for Medicare Part B in 2025 is $185 per month, and this amount may vary depending on individual circumstances.
In summary, preventive services under Medicare Part B aim to promote early detection and illness prevention. By covering certain screenings, tests, and scans, Medicare Part B can help individuals detect health issues early and potentially improve their treatment outcomes. It is important to review the specific coverage details and stay informed about any changes or updates to the included preventive services.
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Outpatient care
Medicare Part B covers medically necessary outpatient services and preventive care for people aged 65 and above, and those under 65 with a disability or specific health condition. It covers 80% of Medicare-approved services, leaving the insured person 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.
Outpatient services covered by Part B include surgeries and chemotherapy. However, for surgeries and chemotherapy, expenses can add up to thousands of dollars, and supplemental coverage options are available to help with these costs.
Part B does not cover hospital expenses, cosmetic procedures, routine dental, vision or hearing, routine foot care, or drugs that you pick up yourself at a retail pharmacy.
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Medicare Supplement Insurance (Medigap)
Medicare Part B covers medically necessary outpatient services and preventive care for people aged 65 and above, and those under 65 with a disability or specific health condition. It includes doctor's office visits, preventive care, scans and tests.
Medicare Supplement Insurance, also known as Medigap, is extra insurance purchased to help pay for out-of-pocket costs in Original Medicare. It is important to note that you generally need to have Original Medicare, which includes Part A (Hospital Insurance) and Part B (Medical Insurance), to buy a Medigap policy. During the Medigap Open Enrollment Period (OEP), insurance companies cannot refuse to sell you a Medicare supplement policy, regardless of your health status. They can, however, ask health-related questions on the application and may charge different premiums based on your age or age when you bought the policy.
Medigap policies typically cover most, if not all, Medicare copayment amounts, and they may also cover Medicare deductible amounts, except for the Part B deductible. It is worth noting that Medigap plans should cover the cost of insulin, which is usually $35 or less, if you have Part B and Medigap insurance that pays your Part B coinsurance.
In Indiana, there are eight standard Medigap plans labelled with letters from A to N. These plans are standardized, ensuring that benefits remain the same regardless of the company selling the policy. Plan A is the basic benefit package, and Plans H, I, and J are no longer offered. Plans C and F are exclusively available to individuals who were eligible for Medicare before January 2020, and high-deductible versions of Plans F and G are also available.
If you are considering purchasing a Medigap plan, it is important to be mindful of potential late enrollment penalties. Signing up for Part B when you become eligible is crucial to avoid these additional costs.
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Medicare Advantage
If you have signed up for Medicare Advantage, you will still need to pay a Part B premium. Additionally, before joining a Medicare Advantage Plan, it is important to talk to your employer, union, or benefits administrator about their rules, as joining may cause you to lose your employer or union coverage.
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Frequently asked questions
Part B Medical Insurance, or Medicare Part B, is medical insurance that covers medically necessary services and preventive services.
Part B covers medically necessary outpatient services and preventive care. This includes doctor's office visits, scans, tests, x-rays, bloodwork, diabetic test strips, nebulizers, and wheelchairs.
Part B Medical Insurance is available to those who are 65 or older, as well as those under 65 with a disability or specific health condition.
Most people pay a Medicare Part B premium of $185 per month. There may also be additional out-of-pocket costs, deductibles, coinsurance, and copays.
It is recommended to sign up for Part B when you become eligible for Medicare at age 65 to avoid late enrollment penalties.
