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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
Copayments or coinsurance vary by service and Medicare Advantage Plan. Many covered preventive services may have $0 cost-sharing. You must continue paying your Part B premium to stay in your plan. Medicare Advantage Plans have a yearly out-of-pocket limit for covered Part A and Part 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
Your copayment or coinsurance for durable medical equipment varies by Medicare Advantage Plan, equipment, and supplier. Using a plan-approved, in-network supplier may help you avoid higher costs.
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
Many Medicare-covered preventive services have $0 cost-sharing when you meet the eligibility requirements. Costs may apply for additional tests or services performed during the same visit. You must continue paying 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 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
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
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
Your plan may require you to use an in-network, Medicare-certified home health agency. Services may require prior authorization. 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: 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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