Medicare Part B is Medical Coverage by doctors in an outpatient setting.

While Medicare Part A is premium-free if you have worked for 10 years or 40 quarters, Medicare Part B comes with a monthly premium. Presently, in 2020, the Part B premium is $144.60 for most beneficiaries. The Part B premium is income tested, however, and the following table shows the premiums as laid out for a range of income bands:

Grid showing the Income Related Medicare Adjustment Amount (IRMAA) for Medicare Part B based on income bands

What Does Medicare Part B Cover?

Subject to the annual deductible and a 20% copayment, Medicare Part B covers the cost of medically necessary doctor visits and other outpatient services. For example:

  • Doctors’ medically-necessary services (Both inpatient and outpatient)
  • Outpatient care at hospitals and clinics
  • Organ transplants and immunosuppressive drugs
  • Lab tests, x-rays, MRIs, CT scans, and EKGs
  • Some diagnostic screenings
  • Physical, occupational, and speech therapy
  • Dental work (only as required due to accident or disease)
  • Vision care only as related to disease
  • One pair of eyeglasses following cataract surgery
  • Hearing care only as related to disease
  • Foot care (only as required due to accident or disease)
  • Mental health, both inpatient and outpatient
  • Ambulance services considered medically necessary
  • Some preventive services (Pap smears, mammography, flu shots, certain vaccines and antigens
  • Initial Welcome to Medicare visit within the first twelve months that you have Part B
  • Annual Wellness visit (This is not a full physical but more of a conversation regarding your current state of health and your health goals.
  • Screening tests for detection of diabetes, heart disease, or prostate cancer
  • Smoking cessation programs
  • Durable medical equipment
  • Blood – after the first three pints.

There are some services covered under Medicare Part B that do not require the payment of the 20% coinsurance. They are:

  • A Medicare-required second opinion for surgery
  • Home health services (A 20% co-insurance payment for durable medical equipment does apply)
  • Pneumonia vaccination or influenza shot
  • Clinical diagnostic lab tests performed on an outpatient basis by doctors who accept assignment or my Medicare-certified facilities.

What Services Aren't Covered Under Medicare Part B?

  • Long-term care, also called custodial care
  • Most prescription drugs
  • Private-duty nursing
  • Any medical services deemed by Medicare to be unnecessary, or services performed by a relative for which the patient is not obligated to pay
  • Medical care outside the U.S. (Except for emergency care
  • Routine dental care
  • Routine eye exams for prescribing glasses
  • Routing hearing exams for hearing aids or exams for fitting them
  • Routing foot care
  • Acupuncture
  • Cosmetic surgery

Medicare Excess Charges

One thing to be aware of regarding what you may owe under Medicare Part B is the pesky matter of Excess Charges.

Health-care providers who care for Medicare patients have the choice of whether they will accept Medicare’s payment as payment-in-full or if they want to come back and bill the patient for the remaining amount Medicare didn’t pay. On the positive side, about 96% of providers have agreed to accept Medicare’s payment as their final payment and this is know as accepting Medicare assignment. Those providers who don’t accept assignment are limited to balance billing only 15% of Medicare’s approved amount. (Limiting Charge Rule)

There are Medicare Supplement (Medigap) Plans that are written to specifically cover these excess charges.

Fortunately for some, there are eight states that have signed legislation known as the Medicare Overcharge Measure (MOM). In these states, providers are prohibited from balance billing patients for excess charges.

These eight MOM states are:

  • Connecticut
  • Massachusetts
  • Rhode Island
  • Vermont
  • New York
  • Pennsylvania
  • Ohio
  • Minnesota

How Much Could My Medical Cost Under Part B?

In 2019, CNBC wrote that a couple retiring in 2019 would need $390,00 to cover their lifetime health-care costs. That’s an alarming amount of exposure for the average couple’s retirement nest egg and it’s because Medicare has no maximum out-of-pocket spending cap. A serious illness, cancer, for example, can quickly decimate a couple’s accounts wiping out years of  savings in a very brief time. 

Fortunately, there are plans available that can plug the gaps in the Medicare program, and for a relatively small amount of money.

We represent all the major insurance providers and can assist you in putting a plan in place that will completely protect you from this unlimited risk. And our services are always FREE!

Just two years after a client came to us for such a plan, she was diagnosed with cancer. Sue’s course of chemotherapy and hospitalizations for the accompanying side effects were followed by bills that exceeded $350,000. Fortunately, Sue had a Medicare Supplement plan that covered the entire amount except for the Part B deductible, which was $185.00 in the year of her illness. A policy that only cost $105.00 per month limited Sue’s exposure to just the deductible amount of Medicare Part B. All her other bills were paid and she was able to receive her treatment without having to worry about the cost. What a blessing, and for such a small monthly premium payment.

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