Understanding Part B: Medical Insurance

While Part A covers “inpatient” care, Medicare Part B covers a wide range of “outpatient” services and supplies. This is the part of your healthcare for seniors that you will likely use most often for routine medical needs. Unlike Part A, everyone pays a monthly premium for Part B.

What Part B Covers

Part B is comprehensive and helps pay for services that are medically necessary to treat your health condition. It also places a strong emphasis on preventive care to keep you healthy.

Doctor’s Services: This includes visits to your primary care doctor and specialists, whether in their office or during a hospital stay. It also covers the services of other healthcare providers like nurse practitioners and physician assistants.

Outpatient Care: This covers services you receive in a hospital outpatient setting, such as in an emergency room, for observation, or for outpatient surgery.

Preventive Services: Part B covers many screenings and services to prevent illness or detect it at an early stage. This includes an annual “Wellness” visit, flu shots, pneumonia shots, cancer screenings (like mammograms and colonoscopies), and screenings for conditions like diabetes and heart disease.

Durable Medical Equipment (DME): This includes items like walkers, wheelchairs, and oxygen equipment that your doctor prescribes for use in your home.

Ambulance Services: It covers ground ambulance transportation when you need to be transported to a hospital or skilled nursing facility for medically necessary services.

It is also important to know what Part B generally does not cover. This includes most dental care, eye exams for prescription glasses, dentures, cosmetic surgery, and hearing aids. These are significant gaps that you will need to plan for separately.

What Part B Costs You

The costs for Part B have a few components that work together:

Monthly Premium: Most people pay a standard monthly premium. In 2024, the standard premium is $174.70, but this amount can change each year. The premium is typically deducted directly from your Social Security benefit payment. If you are not yet collecting Social Security, you will receive a bill.

Income-Related Monthly Adjustment Amount (IRMAA): If your modified adjusted gross income as reported on your tax return from two years ago is above a certain amount, you will pay a higher Part B premium. This is known as IRMAA. The Social Security Administration will notify you if you are required to pay this higher amount.

Annual Deductible: Before Medicare starts to pay its share, you must first pay an annual deductible. For 2024, this amount is $240. You pay this once per year for all your Part B-covered services.

Coinsurance: After you have met your deductible for the year, you typically pay 20% of the Medicare-approved amount for most services. Medicare pays the other 80%. This 20% coinsurance has no annual limit. If you need extensive outpatient treatment, your 20% share could add up to a very large number. This financial risk is another major reason why people explore other coverage options.