Medicare Part B—What's covered?

Part B (Medical Insurance) Helps cover: 

• Services from doctors and other health care providers 
• Outpatient care 
• Home health care 
• Durable medical equipment (like wheelchairs, walkers, hospital beds, and other equipment) 
• Many preventive services (like screenings, shots or vaccines, and yearly “Wellness” visits) 

Part B covers 2 types of services 

1. Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice. 
2. Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best.

You pay nothing for most preventive services if you get the services from a health care provider who accepts  assignment.  

Part B covers things like:

• Clinical research studies: test different types of medical care, including new treatments, to find out how well they work and if they’re safe.
• Ambulance services: when traveling in any other vehicle could endanger your health, and you need medically necessary services from a Hospital or Skilled nursing facility. Medicare may pay for emergency ambulance transportation in an airplane or helicopter if you need immediate and rapid transport that ground transportation can’t provide.
• Durable medical equipment (DME): If your doctor prescribes them as medically necessary for use in your home.
  •  Examples: Canes, CPAP devices, crutches, hospital beds, oxygen equipment, suction pump, walkers, wheelchairs and scooters, and more. 
• Mental Health: 
  
  • Inpatient: Covered by Medicare Part A
  • Outpatient: One depression screening per year, family counseling, psychiatric evaluation, medication management, diagnostic tests, and more. 
  • Partial hospitalization: May cover a partial hospitalization program if you meet certain requirements and your doctor certifies that you would otherwise need inpatient treatment.
• Limited outpatient prescription drug: 
  • Drugs used with an item of durable medical equipment (DME): Medicare covers drugs infused through DME, like an infusion pump or a nebulizer, if the drug used with the pump is reasonable and necessary. 
  • Some antigens: Medicare helps pay for antigens if a doctor prepares them and a properly instructed person (who could be you, the patient) gives them under appropriate supervision.
  • Injectable osteoporosis drugs: when you meet certain conditions. 

In addition, Medicare will cover the home health nurse or aide to provide the injection if your family and/or caregivers are unable or unwilling to give you the drug by injection.

Some other examples of Part B covered drugs include: 

• Erythropoiesis-stimulating agents: If you have End-Stage Renal Disease (ESRD) or you need this drug to treat anemia related to certain other conditions. 
• Blood clotting factors: Clotting factors you give yourself by injection, if you have hemophilia. 
• Injectable and infused drugs: Medicare covers most injectable and infused drugs when a licensed medical provider gives them, because these types of drugs aren't usually self-administered.
• Oral End-Stage Renal Disease (ESRD) drugs: Medicare helps pay for some oral ESRD drugs if the same drug is available in injectable form and the Part B ESRD benefit covers it.
• Parenteral and enteral nutrition (intravenous and tube feeding) 
• Intravenous Immune Globulin (IVIG) provided in home: If you have a diagnosis of primary immune deficiency disease, and your doctor decides that it's medically appropriate for you to get the IVIG in your home.

Part B covers the IVIG itself, but doesn't pay for other items and services related to you getting the IVIG at home.

The 2022 Part-B premium is $170.10 per month (premiums will be higher for individuals with annual incomes of $91,000 or more and married couples with annual incomes of $182,000 or more.)

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