Not everyone can enroll in Medicare Part B. People living in the US who become entitled to premium-free Part A are automatically enrolled in Part B. Since Part B is a voluntary program which requires the payment of a monthly premium, people who do not want Part B coverage may refuse enrollment.
A person age 65 or older who is not entitled to premium-free Part A must meet the following requirements to qualify for Part B:
- Must be a US resident; and
- Must be either a citizen, or an immigrant who has been lawfully admitted for permanent residence with 5 years continuous residence in the US prior to the month of filing.
Everyone enrolled in Part B must pay a premium for Part B. This includes persons who do not have to pay a premium for Part A.
As of 2017, the Part B premium is $134 if you are newly enrolled, or your premium is not auto-deducted from your Social Security check, or if your income is $85,000 or less. If you pay your Part B premium through your monthly Social Security benefit, you’ll pay less ($109 on average). If your income is above $85,000 your Part B premium can be significantly more.
Medicare Part B covers a wide range of medical services, which include:
- Medical services of a doctor received in any setting
- Outpatient hospital care
- X-rays and laboratory tests
- Ambulance transport
- Physical and occupational therapy
- Home health care (if you do not have Part A coverage)
- Flu and pneumonia shots
- Pap smears and mammograms
- Outpatient mental health care
- Durable medical equipment, such as wheelchairs and hospital beds
- Artificial limbs
- Medical supplies, such as ostomy bags, dressings and splints
Medicare Part B does not cover:
- Routine dental care
- Hearing aids
- Prescription medications
You must pay the Part B annual deductible toward Part B covered services. As of 2017, this is $183 per year.
Thereafter, Medicare pays 80% of the Medicare approved charge. You pay the Part B coinsurance amount, which is the remaining 20%. The Medicare approved charge is the amount that the CMS has determined is fair reimbursement to the medical provider for the services provided.
Centers for Medicare and Medicaid Services (CMS) issues a handbook called Medicare & You that contains a thorough summary of covered services.
Many preventive services will be provided at no cost to you. These free benefits will not be affected by the deductible.
If you get Medicare benefits, you are eligible for a preventive wellness visit when you’re new to Medicare, and one each year after that. But don’t confuse these with full physical examinations. These are prevention-focused visits that provide only an overview of your health and medical risk factors, and serve as a baseline for future care.
In addition, Medicare also offers the following:
- Free smoking cessation counseling
- Medical nutrition therapy to help beneficiaries with diabetes or kidney disease
- Depression screenings
- Alcohol screening and counseling
- Obesity screening and counseling
- Annual cardiovascular risk reduction visits
- Sexually transmitted infection screening and counseling, and
- HIV screenings.
Updated: December 2016