Part B medical insurance covers doctor bills for treatment in or out of the hospital, as well as the costs of medical equipment, tests and services provided by clinics and laboratories. You have to pay for other medical expenses, such as routine physical examinations, medications, glasses, hearing aids and dentures.
Some of the items Medicare Part B insurance pays for include:
- Doctor services, including surgery, provided at a hospital, a doctor’s office or your home.
- Mammograms, pelvic exams, bone density tests and PAP smears for women.
- Prostate Specific Antigen (PSA) tests for men.
- Flu shots.
- Colorectal cancer screenings such as colonoscopies and flexible sigmoidoscopies.
- Medical services provided by nurses, surgical assistants or laboratory or X-ray technicians.
- Outpatient hospital treatment, such as emergency room or clinic charges, X-rays injections and lab work.
- Home health care, including part-time skilled nursing care, physical therapy, occupational therapy, home health aide services and durable medical equipment needed at home during an illness.
- An ambulance, if required for a trip to or from a hospital or skilled nursing facility.
- Medical equipment and supplies.
- Diabetes service and supplies.
- Glaucoma screening for high risk individuals.
- Emergency care.
- Prosthetic devices (including prosthetic breast after a mastectomy).
You may be able to successfully appeal cases when Medicare denies coverage for procedures that your doctor deems “medically necessary.”
Your chances of winning are good. According to the Medicare Rights Center, 80 percent of Medicare Part A appeals and 92 percent of Part B appeals turn out in favor of the person appealing.
What it Costs
While Part A Medicare coverage is free for many people, Part B coverage costs $104.90 a month in 2014 (unchanged from 2013) when an individual has an annual income of $85,000 or $170,000 for married couples filing joint tax returns.
When Medicare B does cover an item, it generally pays 80 percent of the amount it approves, after a $147 deductible in 2014 (unchanged from 2013) and you pay the remaining 20 percent. Part B insurance pays 100 percent of approved charges for home health care, clinical laboratory services and flu and pneumonia vaccines.
For a complete list of services covered by Medicare Part B, or more specific information on what you pay and what Medicare pays, click here to review the publications on the Medicare website.
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