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Understanding
Medical Coverage
Part B
Part B helps cover: Doctor Visits, Outpatient Care, Preventive Services, Lab Tests, and Durable Medical Equipment. Most people pay a monthly premium for Part B, and some costs (like copays and coinsurance) apply after you meet the annual deductible.
When It Applies
When you receive outpatient medical care (doctor/clinic visits or outpatient facility services) through your Medicare Advantage plan—typically at in-network providers.
What's Covered
Primary care and specialist visits, preventive services, outpatient surgery/procedures, lab work and imaging, outpatient mental health, physical/occupational/speech therapy, ambulance (when covered), and certain durable medical equipment.
How Long You're
Covered
As long as services are medically necessary, covered by the plan, and you follow plan rules (referrals/prior authorization may apply).
What You'll Pay
Plan-set copays or coinsurance (varies by service and plan). Many preventive services are $0 when in-network. You must keep paying your Part B premium, and every MA plan has a yearly out-of-pocket maximum for Part A & B services.
Doctor & Outpatient Services
*Use in-network providers whenever possible to avoid higher costs. Prior authorization may be required for some services. You must continue to pay your Part B premium.
When It Applies
When your provider orders medically necessary equipment for use at home and you use a plan-approved, in-network supplier (prior authorization may apply).
What's Covered
Walkers, wheelchairs, hospital beds, oxygen equipment, nebulizers, CPAP/BiPAP machines and supplies, blood sugar monitors and test strips, and other approved durable equipment.
How Long You're
Covered
As long as the equipment is medically necessary and approved by your plan; some items are rented month-to-month or require periodic recertification.
What You'll Pay
Plan-set copay or coinsurance (often around 20%), varying by item and supplier. Out-of-network suppliers (if allowed) may cost more.
Durable Medical Equipment (DME)
*Use a plan-approved, in-network supplier. Prior authorization may be required. You must continue to pay your Part B premium.
When It Applies
When you receive routine or scheduled preventive care.
What's Covered
“Welcome to Medicare” visit (first 12 months), Annual Wellness Visit, and many screenings (e.g., mammograms, colorectal cancer/colonoscopy, diabetes, depression, bone density, abdominal aortic aneurysm if eligible). Part B vaccines: flu, COVID-19, and pneumococcal; hepatitis B for medium/high risk.
How Long You're
Covered
As recommended by Medicare and your provider (frequency limits and eligibility rules apply).
What You'll Pay
Typically $0 in-network when Medicare criteria are met and billed as preventive. Diagnostic follow-ups or out-of-network care may have copays/coinsurance. You must continue to pay your Part B premium.
Preventive Services & Screenings
*$0 cost may apply only when services meet plan criteria and are received from in-network providers. You must continue to pay your Part B premium.
When It Applies
You’re homebound and your doctor orders skilled home health care from a Medicare-certified, in-network agency (prior authorization may apply).
What's Covered
Intermittent skilled nursing; physical/occupational/speech therapy; part-time home health aide when skilled care is needed; medical social services; certain medical supplies from the agency. (Durable medical equipment is covered separately under Part B rules.)
How Long You're
Covered
Services are reviewed regularly and continue as long as they’re medically necessary, you remain homebound, and care is ordered by your doctor.
What You'll Pay
Typically $0 for covered home health services with in-network agencies. You pay your plan’s cost-share for DME (often about 20%); amounts vary by plan and supplier. You must keep paying your Part B premium.
Home Health Services
*Must use an in-network, Medicare-certified agency. Services are reviewed regularly for medical necessity and may require prior authorization. You must continue to pay your Part B premium.
Quick Basics about Part B
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You’ll pay a monthly premium (most people pay the standard rate set by Medicare).
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There’s an annual deductible, then usually 20% coinsurance for most Part B services.
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Part B does not cover routine dental, vision, hearing aids, or most prescription drugs (those are covered under Part D).
*****Disclaimer: The information above describes Medicare Advantage (Part C) plan coverage for Part B services. Costs, copays, coinsurance, and coverage rules vary by plan and provider network. This is not a description of Original Medicare. You must continue to pay your Medicare Part B premium.
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