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What Does Medicare Part B Cover
What Is Covered

Medicare covers services (like lab tests, surgeries, and doctor visits) and supplies (like wheelchairs and walkers) considered medically necessaryto treat a disease or condition.If you're in a Medicare Advantage Plan or other Medicare plan, you may have different rules, but your plan must give you at least the same coverage as Original Medicare. Some services may only be covered in certain settings or for patients with certain conditions.

*Part B has a standard monthly premium of $144.60 (or higher depending on your income).

*Most people pay a monthly part B premium of $144.60. If your income is above certain levels, you may pay a higher amount based on the amount of your income. This is called Income Related Monthly Adjustment Amount, or IRMAA. Below is the IRMAA chart for 2020. (your IRMAA is determined based on 2 tax years prior. If you have had any changes in income in the passed two tax years that would effect your IRMAA, you may contact Social Security to file paperwork for an adjustment.)

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Part B covers 2 types of services

  • Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice. These services have a calendar year deductible of $198.00. Once you have paid $198.00 for the calendar year, you pay 20% and Medicare pays 80% of the bills for outpatient services. 

  • 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 Medicare assignment.

Part B covers things like:

 

  • Clinical research

  • Ambulance services

  • Durable medical equipment (DME)

  • Mental health (Inpatient, Outpatient, Partial hospitalization)

  • Getting a second opinion before surgery

  • Limited outpatient prescription drugs

 

 

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