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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, including doctor visits, clinic services, or outpatient facility services.
What's Covered
Primary care and specialist visits, preventive services, outpatient procedures, lab work and imaging, outpatient mental health care, therapy, ambulance services when covered, and certain durable medical equipment.
How Long You're
Covered
Coverage continues as long as services are medically necessary and meet your plan’s coverage requirements. Network, referral, or prior authorization requirements may apply.
What You'll Pay
Copayments or coinsurance vary by service and Medicare Advantage plan. Medicare Advantage plans have an annual out-of-pocket limit for covered Part A and Part B services. You must continue paying your Part B premium.
Doctor & Outpatient Services
Network, cost-sharing, referral, and prior authorization requirements vary by plan and service area.
Review your Evidence of Coverage for details
When It Applies
When your provider orders medically necessary equipment for use at home. Supplier and authorization requirements may vary by plan.
What's Covered
Walkers, wheelchairs, hospital beds, oxygen equipment, nebulizers, CPAP/BiPAP machines and supplies, blood sugar monitors and test strips, and other covered durable medical equipment.
How Long You're
Covered
Coverage continues as long as the equipment remains medically necessary and meets your plan’s coverage requirements. Some equipment may be rented or require periodic recertification.
What You'll Pay
Cost-sharing for durable medical equipment varies by Medicare Advantage plan, equipment, and supplier. Review your plan’s Evidence of Coverage for details
Durable Medical Equipment (DME)
Supplier, network, cost-sharing, and prior authorization requirements vary by plan and service area. You must continue paying your Part B premium.
When It Applies
When you receive routine or scheduled preventive care.
What's Covered
“Welcome to Medicare” visit, Annual Wellness Visit, and Medicare-covered preventive screenings and vaccines when eligibility requirements are met.
How Long You're
Covered
As recommended by Medicare and your provider. Frequency limits and eligibility requirements may apply.
What You'll Pay
Cost-sharing for preventive services depends on Medicare coverage rules and your plan. Some covered preventive services may have no cost-sharing when eligibility requirements are met. Additional tests or services performed during the same visit may have costs. You must continue paying your Part B premium.
Preventive Services & Screenings
Coverage, cost-sharing, network, and eligibility requirements may vary by service and plan. Review Medicare.gov or your Evidence of Coverage for details.
When It Applies
You’re homebound and a doctor or other health care provider orders part-time or intermittent skilled home health care from a Medicare-certified home health agency
What's Covered
Skilled nursing, physical/occupational/speech therapy, part-time home health aide services when skilled care is also needed, medical social services, and certain medical supplies. Durable medical equipment may have separate coverage and cost-sharing requirements.
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
Costs for covered home health services and durable medical equipment vary by Medicare Advantage Plan. Check your plan for specific costs and coverage requirements. You must continue paying your Part B premium
Home Health Services
Network and prior authorization requirements vary by plan and service area. You must continue paying 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 generally does not cover routine dental care, routine eye exams for prescribing glasses, hearing aids, or most outpatient prescription drugs.
Disclaimer: This page provides general educational information about Medicare Part B and Medicare Advantage coverage of Part B services. Original Medicare costs and coverage rules may change. Medicare Advantage plan costs, networks, prior authorization requirements, and coverage details vary by plan and service area.
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