Medicare Part B helps cover medical services such as doctors’ visits, outpatient care, and other medical services that Medicare Part A does not cover. Medicare Part B pays for covered medical services and items when they are medically necessary, as well as some preventive services.
Medicare Part B is optional, and it requires a monthly premium. Most people pay $96.40 per month for their Medicare Part B premium in 2010. However, the premium could be higher if you did not sign up for Medicare Part B when you first became eligible. For example, if you do not sign up for Medicare Part B when you are first eligible, the premium for Medicare Part B will go up 10% for each full 12-month period that you could have had Medicare Part B, but didn’t sign up for it. If you later decide to sign up for Medicare Part B, you may have to pay this higher premium amount for as long as you have Medicare Part B.
Generally, your monthly premium for Medicare Part B will be higher if you filed an individual tax return and your annual income was over $85,001 in 2008, or if you are married, filed a joint tax return, and your annual income was over $170,001. (These amounts will change each year). Based on this, if your income exceeded these amounts, Social Security will use the income reported two years prior on your IRS income tax return to determine your Medicare Part B premium. For example, the income reported on your 2008 tax return will be used to determine your monthly Medicare Part B premium for 2010. Note that if your income has decreased since 2008, you can ask that the income from a more recent tax year be used to determine your Medicare Part B premium.
You also pay a deductible each year for Medicare Part B before Medicare will pay for services.
Medicare Part B primarily covers two types of services. These include medically necessary services, and preventive services.
Services that Medicare Part B covers include:
• Ambulance Services. When you need to be transported to a hospital or skilled nursing facility.
• Ambulatory Surgery Center. Facilities are covered for Medicare Part B approved services.
• Blood. Pints of blood you receive as an outpatient or as part of a Medicare Part B-covered service.
• Bone Mass Measurement. To see if you are at risk for broken bones. This service is covered by Medicare Part B once every 24 months – or more often if medically necessary – under certain medical conditions.
• Cardiovascular Screenings. Every five years to test your cholesterol, lipid, and triglyceride levels to help prevent a heart attack or stroke.
• Chiropractic Services (Limited). For manipulation of the spine.
• Clinical Laboratory Services. Including blood tests, urinalysis, and some screening tests.
• Clinical Trials. Some costs may be covered by Medicare Part B if you take part in a qualifying clinical trial.
• Colorectal Cancer Screenings. To help find precancerous growths, and help prevent or find cancer early.
• Diabetes Screenings. To check for diabetes. These screenings are covered by Medicare Part B if you have any of the following risk factors: high blood pressure, dyslipidemia (history of abnormal cholesterol and triglyceride levels), obesity, or history of high blood sugar.
• Diabetic Self-Management Training. Your doctor or other health care provider must provide a written order in order to be covered by Medicare Part B.
• Diabetic Supplies. Including glucose testing monitors, blood glucose test strips, lancet devices and lancets, glucose control solutions, and therapeutic shoes (in some cases). Syringes and insulin are only covered by Medicare Part B if used with an insulin pump or if you have Medicare prescription drug coverage.
• Doctor Services. Medicare Part B doesn’t cover routine physical exams except for a one-time “Welcome to Medicare” Physical Exam.
• Durable Medical Equipment. Items such as oxygen, wheelchairs, walkers, and hospital beds needed for use in the home are generally covered by Medicare Part B.
• Emergency Room Services. When you believe your health is in serious danger if you have a bad injury, sudden illness, or an illness that quickly gets much worse.
• Eyeglasses (Limited). Medicare Part B covers one pair of eyeglasses with standard frames after cataract surgery that implants an intraocular lens.
• Flu Shots. To help prevent influenza or flu virus. This is covered by Medicare Part B once per flu season.
• Foot Exams and Treatment. If you have diabetes-related nerve damage and/or meet certain conditions, Medicare Part B may provide coverage.
• Glaucoma Tests. Covered by Medicare Part B once every 12 months for people at high risk for glaucoma. Tests must be done by an eye doctor.
• Hearing and Balance Exam. If your doctor orders it to see if medical treatment is needed. Hearing aids and exams for fitting hearing aids are not covered by Medicare Part B.
• Hepatitis B Shots. To help protect people from getting Hepatitis B. This is covered (three shots) by Medicare Part B for people with Medicare who are at high or medium/intermediate risk.
• Home Health Services. Limited to reasonable and necessary part-time or intermittent skilled nursing care and home health care aide services as well as physical therapy, occupational therapy, and speech-language pathology that are ordered by your doctor and provided by a Medicare-certified home health agency. Also includes medical social services, other services, durable medical equipment (wheelchairs, hospital beds, oxygen, and walkers), and medical supplies for use at home.
• Kidney Dialysis Services and Supplies. Either in a facility or at home.
• Mammograms. Preventive screening mammograms are covered by Medicare Part B once every 12 months for all women with Medicare.
• Medical Nutrition Therapy Services. For people who have diabetes or renal disease with a doctor’s referral.
• Mental Health Care (Outpatient). Certain conditions apply.
• Occupational Therapy. Services given to help you return to usual activities after an illness.
• Outpatient Hospital Services. Received as an outpatient as part of a doctor’s care.
• Outpatient Medical and Surgical Services and Supplies. For Medicare Part B approved procedures.
• Pap Test and Pelvic Exam (Includes Clinical Breast Exam). To check for cervical and vaginal cancers. Medicare Part B covers these exams under certain conditions.
• Physical Exam (One-Time “Welcome to Medicare” Physical Exam). A one-time review of your health, and education and counseling about preventive services, including certain screenings and shots. Getting referrals for other care, if you need it, are also covered by Medicare Part B. You must have the physical exam within the first six months that you have Medicare Part B. Deductibles and coinsurance apply.
• Physical Therapy. Treatment of injuries and disease by mechanical means, such as heat, light, exercise, and massage.
• Pneumococcal Shot. To help pneumococcal infections.
• Practitioner Services. Such as those provided by clinical social workers, physician assistants, and nurse practitioners are covered by Medicare Part B.
• Prescription Drugs. Limited, like certain injectable cancer drugs.
• Prostate Cancer Screening. To help find prostate cancer. Medicare Part B covers a preventive digital rectal exam and Prostate Specific Antigen (PSA) test once every 12 months for all men with Medicare over age 50.
• Prosthetic/Orthotic Items. Including arm, leg, back, and neck braces; artificial eyes; artificial limbs (and their replacement parts); breast prostheses (after mastectomy); prosthetic devices needed to replace an internal body part or function (including ostomy supplies and parenteral and enteral nutrition therapy).
• Second Surgical Opinions. Covered by Medicare Part B in some cases (some third surgical opinions are covered by Medicare Part B) for surgery that isn’t an emergency.
• Smoking Cessation Counseling. Provided at any provider site if ordered by your doctor. Includes up to eight face-to-face visits during a 12-month period if you are diagnosed with a smoking-related illness or are taking medicine that may be affected by tobacco.
• Speech-Language Pathology Services. Treatment given to regain and strengthen speech skills.
• Surgical Dressings. For treatment of a surgical or surgically treated wound.
• Telemedicine. Services in some rural areas, under certain conditions in a practitioner’s office, a hospital, or a federally-qualified health center.
• Tests. Including x-rays, MRI’s, CT scans, EKG’s, and some other diagnostic tests.
• Transplant Services. Including heart, lung, kidney, pancreas, intestine, and liver transplants under certain conditions and in a Medicare-certified facility only. Bone marrow and cornea transplants can also be covered by Medicare Part B (under certain conditions). Immunosuppressive drugs are covered by Medicare Part B if the transplant was paid for by Medicare, or paid by an employer or union group health plan that was required to pay before Medicare (you must have been entitled to Medicare Part A at the time of the transplant and entitled to Medicare Part B at the time you get immunosuppressive drugs, and the transplant must have been performed in a Medicare-certified facility).
• Travel (Health Care Needed When Travelling Outside the United States). Limited to medical services provided in Canada when you travel on the most direct route through Canada between Alaska and another state. Medicare Part B also covers hospital, ambulance, and doctor services if you are in the United States, but the nearest hospital that can treat you isn’t in the United States (the “United States” means the 50 states, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa). In some cases, Medicare Part B may pay for services that you get while on board a ship within the territorial waters adjoining the land areas of the United States.
• Urgently Needed Care. To treat a sudden illness or injury that isn’t a medical emergency.

Note: All above services may require the use of Medicare Part B coinsurance and/or deductibles.