Medicare Part B helps pay for doctors’ services, outpatient hospital care, medical supplies, and some other medical services that Medicare Part A does not cover, such as the services of physical, occupational, and speech therapists in an outpatient setting, and some home health care. Part B also covers outpatient mental health care.
Other services covered by Medicare Part B include, but are not limited to, the following:
- Clinical laboratory services: blood tests, urinalysis, and more
- Home health services: part-time skilled care, home health aide services
- Durable medical equipment when supplied by a home health agency while getting Medicare-covered home health care, and other supplies and services
- Outpatient hospital services: services for the diagnosis or treatment of an illness or injury
- Blood: pints of blood needed as an outpatient or as part of a medical service covered by Medicare Part B, after the first 3 pints
- Ambulance service: when other transportation would endanger your health (For more information on coverage, payment, and rights and protection issues related to ambulance services, get a copy of Medicare Coverage of Ambulance Services, CMS Pub. No. 11021, by visiting www.medicare.gov on the web.)
- Part B also covers some preventive services
Medicare Part B also covers preventive services like exams, lab tests, and screenings to help prevent, find, or manage a medical problem. Preventive services may find health problems early, when treatment works best. The Medicare & You handbook includes guidelines for who is covered and how often Medicare will pay for these services.
New in 2011, many preventive services are free!*
What Preventive Services are covered?
- One-time "Welcome to Medicare” Physical Exam
Also called the Initial Preventive Physical Examination, it is a review of your health & medical history, as well as education and counseling about the preventive services you need. To be covered, you must have the physical exam within the first 12 months you have Medicare Part B. Your health care provider may order additional tests or perform an additional exam that is NOT covered at 100%.
- Yearly "Wellness" Exam
Also called the Annual Wellness Visit (AWV), this visit is new to Medicare in 2011. If you've had Medicare longer than one year, talk to your provider about the AWV, which can help develop or update a personalized prevention plan.
- Cardiovascular Screening
Once every 5 years, Medicare covers tests for cholesterol, lipid and triglyceride levels.
- Breast Cancer Screening
Women age 40+ are eligible for a screening mammogram every 12 months. One baseline mammogram is covered for women ages 35-39.
- Cervical & Vaginal Cancer Screening
Pap test, pelvic & clinical breast exam covered every 24 months, or every 12 months for women at high risk.
- Colorectal Cancer Screening
Everyone age 50+ (although there is no minimum age for having a screening colonoscopy) is covered for a fecal occult blood test every 12 months; flexible sigmoidoscopy every 48 months after previous flexible sigmoidoscopy or barium enema, or 120 months after screening colonoscopy; screening colonoscopy once every 120 months (high risk every 24 months) or 48 months after previous flexible sigmoidoscopy; and barium enema* once every 48 months (high risk every 24 months) when used instead of sigmoidoscopy or colonoscopy.
* Please note that for barium enemas, you pay 20% of the Medicare-approved amount for the doctor's services with no Part B deductible. If it's done in a hospital outpatient setting, you pay a copayment.
- Prostate Cancer Screening
Men age 50+ are covered for a digital rectal examination every 12 months and a PSA test every 12 months. Please note that generally you will pay 20% of the Medicare-approved amount for the digital rectal exam after the annual Part B deductible, but there is no co-insurance or deductible to meet for the PSA test.
- Vaccinations - Flu, Pneumococcal, Hepatitis B
The flu vaccine is covered for everyone once a flu season, in the fall or winter. Most people only need one peumococcal shot in their lifetime. The Hepatitis B vaccine is a series of 3 shots, and it is covered for those determined to be at medium to high risk.
- Bone Mass Measurements
Covered once every 24 months (more often if medically necessary) for those who are at risk for osteoporosis and have other certain medical conditions.
- Diabetes Screening (Fasting Blood Glucose Test)
If you are at high-risk* for developing diabetes, you are covered for this test up to twice a year based on your results.
* Please ask your provider for the Medicare definition, or call CLAIM at 1-800-390-3330 to request a free copy of "Your Guide to Medicare's Preventive Services" booklet.
- Medical Nutrition Therapy
Individuals with diabetes, renal disease (not on dialysis) or who had a kidney transplant in the last 3 years can get a doctor's referral for 3 hours of one-on-one nutrition counseling the first year, and 2 hours each year after that.
- Glaucoma Test
Individuals at high-risk* for glaucoma can have this test once a year. You will pay 20% of the Medicare-approved amount after the yearly Part B deductible.
* Please ask your provider for the Medicare definition, or call CLAIM at 1-800-390-3330 to request a free copy of "Your Guide to Medicare's Preventive Services" booklet.
- Tobacco Use Cessation Counseling
If you are interested in quitting smoking, or stopping use of other tobacco products, and have not been diagnosed with a tobacco-related illness, ask your doctor for a referral to a Medicare-recognized practitioner for up to 8 face-to-face visits during a 12-month period.
- HIV Screening
If you are at high-risk for HIV (Human Immunodeficiency Virus) or would like to request a test, Medicare will cover this test every 12 months (or 3 times during pregnancy), but generally you have to pay your doctor 20% of the Medicare-approved amount for the doctor's visit.
* Please be aware that many preventive services are covered at 100% only if your provider accepts Medicare assignment.
What is not covered by Part B?
Original Medicare doesn’t cover everything. Items and services that aren’t covered include, but aren’t limited to:
- Acupuncture
- Dental care and dentures (with only a few exceptions)
- Cosmetic surgery
- Health care while traveling outside the U.S. (except in limited cases)
- Hearing aids
- Eye care (routine exam), eye refractions, and most eyeglasses
- Long-term care, such as custodial care in a nursing home
