Navigating the healthcare world can often feel like you’re the captain of a ship lost at sea. Like many of the healthcare programs available, Medicare requires a good understanding to ensure your needs are met.
Let’s explore Medicare Part B to get a grasp on what you can expect.
Medicare Part B is a part of Original Medicare that covers medical items, services, and supplies that are medically necessary for your health condition.
Outpatient care, preventative services, ambulance services, and durable medical equipment are examples of covered services and supplies. It also includes part-time home health and rehabilitative services, such as physical or occupational therapy, if ordered by your doctor to treat you.
If you’re enrolled in a Medicare Advantage plan, Medicare Part A and Part B are covered through a private health insurance company contracted by Medicare.
Medicare Advantage plans are required by law to offer at least the same coverage as Original Medicare. Some plans include additional coverage not included such as routine dental and/or vision and/or hearing screenings as well as prescription drug coverage.
Medicare Part B Covers Two Types of Services:
- Medically necessary services – including services or supplies needed to diagnose or treat your medical condition that must meet accepted medical practice standards.
- Preventive services – healthcare services to prevent illness, or detect disease at an early stage
Some preventive services covered under Medicare Part B include a one-time “Welcome to Medicare” preventive visit, cardiovascular screenings, cancer screenings, diabetes screenings, and more. Of note, you pay nothing for most preventive services if you see a health care provider who accepts Medicare.
Part B covers things such as:
- Ambulance services
- Clinical research
- Durable medical equipment (DME)
- Getting a second opinion before surgery
- Limited outpatient prescription drugs
- Mental health
- Partial hospitalization
For an in-depth look at what Medicare Part B covers, be sure to review the Medicare & You Handbook.
How Do I Know If Medicare Part B Covers What I Need?
Here are two ways to find out if Medicare Part B covers what you need.
- Speak with your healthcare provider to understand why you need the services or supplies. In some cases, you may need something that is typically covered, but your provider may feel it won’t be covered in your situation.
If it won’t be covered, you’ll receive a written notice called an “Advance Beneficiary Notice of Noncoverage” (ABN) from your healthcare provider. It is a form you’ll need to read and sign that states you’ll have to pay for the item, service or supply.
- Research to see if Medicare will cover your item, service or supply here.
Medicare coverage is based on 3 main factors:
- State and federal laws
- National coverage decisions regarding coverage made by Medicare
- Local coverage decisions by companies that process Medicare claims in each state. These companies determine if an item, service or supply is medically necessary and should be covered in their specific area.
Medicare Part B covers several items, services, and supplies. To determine precisely what you can expect be sure to explore the Medicare and You handbook.
Disclaimer: the content presented in this article are for informational purposes only, and is not, and must not be considered tax, investment, legal, accounting or financial planning advice, nor a recommendation as to a specific course of action. Investors should consult all available information, including fund prospectuses, and consult with appropriate tax, investment, accounting, legal, and accounting professionals, as appropriate, before making any investment or utilizing any financial planning strategy.