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Medicare Part B

Medicare-Part-B

2024 Medicare Part B Changes

Starting January 1, 2024:

  • The standard monthly premium of Medicare Part B increased to $174.70/month in 2024. (Up from $164.90 in 2023).
  • The annual deductible for Medicare Part B will be $240 per year in 2024. (up from $226 in 2023)
  • Most people pay the standard monthly premium amount ($174.70). If your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount, you may pay an Income Related Monthly Adjustment Amount. The Income Related Monthly Adjustment Amount (IRMAA) brackets have been changed as follows:
Medicare-Part-B-IRMAA-2024

Medicare Part B (Medical Insurance) Helps cover the following:

  • Services from doctors and other healthcare 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)

Medicare Part B (Medical Insurance) helps cover medically necessary doctor’s services, outpatient care, home health services, durable medical equipment, mental health services, and other medical services. Part B also covers many preventive services.
Additional services covered include:

  • Ambulance services
  • Ambulatory surgical centers
  • Cardiac rehabilitation
  • Emergency department services

If you’re enrolled in Original Medicare, it’s important to understand the costs you may be responsible for. If the Part B deductible applies, you are accountable for covering all the expenses (up to the Medicare-approved amount) until you meet the yearly Part B deductible. Once you meet your deductible, Medicare will pay its share, and you will typically pay 20% of the Medicare-approved amount (if the doctor or other healthcare provider accepts the assignment). It’s essential to remember that there’s no yearly limit on the amount you pay out of pocket if you have Original Medicare. However, if you have supplemental coverage like Medigap, Medicaid, employer, retiree, or union coverage, you may have limits on the expenses you pay. By being aware of these costs and your options for supplemental coverage, you can make informed decisions about your healthcare and avoid unexpected expenses.

If you do not sign up for Medicare Part B at the right time, you could be subject to a lifelong penalty.

Doctor & other health care provider services
Medicare covers medically necessary doctor services (including outpatient services and some inpatient hospital doctor services) and most preventive services. Medicare also covers services you get from other health care providers, like physician assistants, nurse practitioners, clinical nurse specialists, clinical social workers, physical therapists, occupational therapists, speech-language pathologists, and clinical psychologists. Except for certain preventive services (for which you may pay nothing if your doctor or other provider accepts assignment), you pay 20% of the Medicare-approved amount for most services. The Part B deductible applies.

If you haven’t received services from your doctor or group practice in the last 3 years, they may consider you a new patient. Check with the doctor or group practice to find out if they’re accepting new patients.

Emergency department services
Medicare covers these services when you have an injury, a sudden illness, or an illness that quickly gets much worse. You pay a copayment for each emergency department visit and 20% of the Medicare-approved amount for doctors’ services. The Part B deductible applies. If your doctor admits you to the same hospital as an inpatient, your costs may be different.

E-visits
Medicare covers E-visits to allow you to talk with your provider using an online patient portal without going to the provider’s office. Providers who can give these services include doctors, nurse practitioners, clinical nurse specialists, physician assistants, physical therapists, occupational therapists, speech-language pathologists, licensed clinical social workers (in specific circumstances), and clinical psychologists (in specific circumstances). To get an E-visit, you must request one with your doctor or other provider. You pay 20% of the Medicare-approved amount for your doctor’s or other provider’s services. The Part B deductible applies.

Telehealth
Medicare covers certain telehealth services provided by a doctor or other health care practitioner who’s located elsewhere using audio and video communication technology (or audio-only telehealth services in some cases), like your phone or a computer. Telehealth can provide many services that generally occur in-person, including office visits, psychotherapy, consultations, and certain other medical or health services.

Virtual check-ins
Medicare covers virtual check-ins (also called “brief communication technology-based services”) with your doctor or certain other providers, like nurse practitioners, clinical nurse specialists, or physician assistants. Virtual check-ins use audio and video communication technology, like your phone or a computer, without you going to the doctor’s office. Your doctor can also conduct remote assessments using photo or video images you send for review to determine whether you need to go to the doctor’s office.

Your doctor or other provider can respond to you by phone, virtual delivery, secure text message, email, or patient portal.

You can use these services if you have met these conditions:

  • You talked to your doctor or other provider about starting these types of visits.
  • The virtual check-in doesn’t relate to a medical visit you’ve had within the past 7 days and doesn’t lead to the medical visit within the next 24 hours (or the soonest appointment available).
  • You verbally consent to the virtual check-in, and your doctor documents your consent in your medical record. Your doctor may get one consent for a year’s worth of these services

Rural Health Clinic services
Rural Health Clinics provide many outpatient primary care and preventive services in rural and underserved areas. Generally, you pay 20% of the charges. The Part B deductible applies. You pay nothing for most preventive services.

Cognitive assessment & care plan services
When you visit your provider (including your yearly “Wellness” visit), they may perform a cognitive assessment to look for signs of dementia, including Alzheimer’s disease. Signs of cognitive impairment include trouble remembering, learning new things, concentrating, managing finances, or making decisions about your everyday life. Conditions like depression, anxiety, and delirium can also cause confusion, so it’s important to understand why you may be having symptoms.

Medicare covers a separate visit with a doctor or health care practitioner to do a full review of your cognitive function, establish or confirm a diagnosis like dementia or Alzheimer’s disease, and develop a care plan. You can bring someone with you, like a spouse, friend, or caregiver, to help provide information and answer questions.

During this visit, the doctor or health care practitioner may:

  • Perform an exam, talk with you about your medical history, and review your medications.
  • Identify your social supports including care that your usual caregiver can provide.
  • Create a care plan to help address and manage your symptoms.
  • Help you develop or update your advance care plan.
  • Refer you to a specialist, if needed.
  • Help you understand more about community resources, like rehabilitation services, adult day health programs, and support groups.

The Part B deductible and coinsurance apply.

Urgently needed care
Medicare covers urgently needed care to treat a sudden illness or injury that isn’t a medical emergency. You pay 20% of the Medicare-approved amount for your doctor or other health care provider services, and a copayment in a hospital outpatient setting. The Part B deductible applies.

Outpatient hospital services
Medicare covers many diagnostic and treatment services you get as an outpatient from a Medicare-participating hospital. Generally, you pay 20% of the Medicare-approved amount for your doctors’ or other health care providers’ services. You may pay more for services you get in a hospital outpatient setting than you’ll pay for the same care in a doctor’s office. In addition to the amount you pay the doctor, you’ll also usually pay the hospital a copayment for each service you get in a hospital outpatient setting (except for certain preventive services that don’t have a copayment). In most cases, the copayment can’t be more than the Part A hospital stay deductible for each service. The Part B deductible applies, except for certain preventive services. If you get hospital outpatient services in a critical access hospital, your copayment may be higher and may exceed the Part A hospital stay deductible.

Outpatient medical & surgical services & supplies
Medicare covers approved procedures, like X-rays, casts, stitches, or outpatient surgeries. You pay 20% of the Medicare-approved amount for doctor or other health care provider services. You generally pay a copayment for each service you get in a hospital outpatient setting. In most cases, the copayment can’t be more than the Part A hospital stay deductible for each service you get. The Part B deductible applies, and you pay all costs for items or services that Medicare doesn’t cover.

Ambulatory surgical centers
Medicare covers the facility service fees related to approved surgical procedures done in an ambulatory surgical center (outpatient facility that performs surgical procedures, and the patient is expected to be released within 24 hours). Except for certain preventive services (for which you pay nothing if your doctor or other health care provider accepts assignment), you pay 20% of the Medicare-approved amount to both the ambulatory surgical center and the doctor who treats you. The Part B deductible applies. You pay all of the facility service fees for procedures Medicare doesn’t cover in ambulatory surgical centers.

Mental health care (outpatient)
Medicare covers mental health care services to help with conditions like depression and anxiety. These visits are often called counseling or psychotherapy, and can be done individually, in group psychotherapy or family settings, and in crisis situations. Coverage includes services generally provided in an outpatient setting (like a doctor’s or other health care provider’s office, or hospital outpatient department), including visits with a psychiatrist or other doctor, clinical psychologist, clinical nurse specialist, clinical social worker, nurse practitioner, or physician assistant.

Medicare covers mental health care services provided by marriage & family therapists and mental health counselors.

Covered mental health care includes partial hospitalization services given by a community mental health center or by a hospital to outpatients. Partial hospitalization is a structured day program that offers outpatient psychiatric services as an alternative to inpatient psychiatric care.

Medicare covers intensive outpatient program services provided by hospitals, community mental health centers, federally qualified health centers, and Rural Health Clinics.

Partial hospitalization and intensive outpatient services are more rigorous than care you’d get in a doctor’s or therapist’s office. Visit Medicare.gov/coverage/ mental-health-care-partial-hospitalization to learn more.

Generally, you pay 20% of the Medicare-approved amount and the Part B deductible applies for mental health care services.

Part A covers inpatient mental health care services you get in a hospital (See Medicare Part A – Inpatient hospital care).

Behavioral health integration services
If you have a behavioral health condition (like depression, anxiety, or another mental health condition), Medicare may pay your provider to help manage that condition. Some providers that manage behavioral health conditions may offer integrated care services, like the Psychiatric Collaborative Care Model. This model is a set of integrated behavioral health services, including care management support that may include:

  • Care planning for behavioral health conditions
  • Ongoing assessment of your condition
  • Medication support
  • Counseling
  • Other treatment your provider recommends

Your health care provider will ask you to sign an agreement for you to get these services on a monthly basis. Your Part B deductible and coinsurance will apply to the monthly service fee.

Opioid use disorder treatment services
Medicare covers opioid use disorder treatment services in opioid treatment programs. The services include medication (like methadone, buprenorphine, naltrexone, and naloxone), substance use counseling, drug testing, individual and group therapy, intake activities, and periodic assessments. Medicare covers counseling, therapy services, and periodic assessments both in-person and, in certain circumstances, by virtual delivery (using audio and video communication technology, like your phone or a computer). Medicare also covers services given through opioid treatment program mobile units.

Medicare pays doctors and other providers for office-based opioid use disorder treatment, including management, care coordination, psychotherapy, and counseling activities.

Under Original Medicare, you won’t have to pay any copayments for these services if you get them from an opioid treatment program provider that’s enrolled in Medicare and meets other requirements. However, the Part B deductible still applies. Talk to your doctor or other health care provider to find out where to go for these services. You can also visit Medicare.gov/ coverage/opioid-use-disorder-treatment-services to find a program near you.

Physical therapy services
Medicare covers evaluation and treatment for injuries and diseases that change your ability to function, or to improve or maintain current function or slow decline, when your doctor or other health care provider, including a nurse practitioner, clinical nurse specialist or physician assistant certifies you need it. You pay 20% of the Medicare-approved amount. The Part B deductible applies.

Occupational therapy services
Medicare covers medically necessary therapy to help you perform activities of daily living (like dressing or bathing). This therapy helps to improve or maintain current capabilities or slow decline when your doctor or other health care provider certifies you need it. You pay 20% of the Medicare-approved amount. The Part B deductible applies.

Speech-language pathology services
Medicare covers medically necessary evaluation and treatment to regain and strengthen speech and language skills. This includes cognitive and swallowing skills, or to improve or maintain current function or slow decline, when your doctor or other health care provider certifies you need it. You pay 20% of the Medicare-approved amount. The Part B deductible applies.

Chiropractic services
The only service ordered by a chiropractor that Medicare covers is manipulation of the spine to correct a subluxation (when the spinal joints fail to move properly, but the contact between the joints remains intact). You pay 20% of the Medicare-approved amount. The Part B deductible applies.

Acupuncture
Medicare only covers acupuncture (including dry needling) for chronic low back pain. Medicare covers up to 12 acupuncture visits in 90 days for chronic low back pain defined as:

  • Lasting 12 weeks or longer
  • Not having an identifiable cause (for example, not an identifiable disease like cancer that has spread or an infectious or inflammatory disease)
  • Pain that isn’t associated with surgery or pregnancy

Medicare covers an additional 8 sessions if you show improvement. You can get a maximum of 20 acupuncture treatments in a 12-month period. The Part B deductible and coinsurance apply. If you aren’t showing improvement, Medicare won’t cover the 8 additional treatments.

Not all providers can give acupuncture, and Medicare can’t pay licensed acupuncturists directly for their services.

Chronic care management services
If you have 2 or more serious chronic conditions (like arthritis and diabetes) that you expect to last at least a year, Medicare may pay for a health care provider’s help to manage those conditions. This includes a comprehensive care plan that lists your health problems and goals, other providers, medications, community services you have and need, and other health information. It also explains the care you need and how it will be coordinated.

If you agree to get this service, your provider will prepare the care plan for you or your caregiver, help you with medication management, provide 24/7 access for urgent care management needs, give you support when you go from one health care setting to another, and help you with other chronic care needs.

You pay a monthly fee, and the Part B deductible and coinsurance apply. If you have supplemental insurance, including Medicaid, it may help cover the monthly fee.

Chronic pain management and treatment services
Medicare covers monthly services for people living with chronic pain (persistent or recurring pain lasting longer than 3 months). Services may include pain assessment, medication management, and care coordination and planning. The Part B deductible and coinsurance apply.

Principal care management services
Medicare covers disease-specific services to help you manage a single, complex chronic condition that puts you at risk of hospitalization, physical or cognitive decline, or death. If you have one chronic high-risk condition that you expect to last at least 3 months (like cancer and you aren’t being treated for any other complex conditions), Medicare may pay for a healthcare provider’s help to manage it. Your provider will create a disease-specific care plan and continuously monitor and adjust it, including the medicines you take. The Part B deductible and coinsurance apply.

Continuous Positive Airway Pressure (CPAP) devices, accessories, & therapy
Medicare may cover a 3-month trial of CPAP therapy (including devices and accessories) if you’ve been diagnosed with obstructive sleep apnea. After the trial period, Medicare may continue to cover CPAP therapy, devices and accessories if you meet with your doctor in person, and your doctor documents in your medical record that you meet certain conditions and the therapy is helping you.

You pay 20% of the Medicare-approved amount for the machine rental and purchase of related supplies (like masks and tubing). The Part B deductible applies. Medicare pays the supplier to rent the machine for 13 months if you’ve been using it without interruption. After you’ve rented the machine for 13 months, you own it.

Note: Medicare may cover a rental or replacement CPAP machine and/or CPAP accessories if you had a CPAP machine before you got Medicare, and you meet certain requirements.

Pulmonary rehabilitation programs
Medicare covers a comprehensive pulmonary rehabilitation program if you have:

  • Moderate to very severe chronic obstructive pulmonary disease (COPD) and have a referral from the doctor who’s treating it.
  • Had confirmed or suspected COVID-19 and experience persistent symptoms that include respiratory dysfunction for at least 4 weeks.

You pay 20% of the Medicare-approved amount if you get the service in a doctor’s office. You also pay a copayment per session if you get the service in a hospital outpatient setting. The Part B deductible applies.

Ambulance services
Medicare covers ground ambulance transportation to a hospital, critical access hospital, rural emergency hospital, or skilled nursing facility for medically necessary services when traveling in any other vehicle could endanger your health. Medicare may pay for emergency ambulance transportation in an airplane or helicopter if you need immediate and rapid ambulance transport that ground transportation can’t provide.

In some cases, Medicare may pay for limited, medically necessary, non-emergency ambulance transportation if you have a written order from your doctor stating that ambulance transportation is medically necessary. For example, someone with End-Stage Renal Disease (ESRD) may need a medically necessary ambulance transport to a facility that provides dialysis.

Medicare will only cover ambulance services to the nearest appropriate medical facility that’s able to give you the care you need.

You pay 20% of the Medicare-approved amount. The Part B deductible applies.

Bariatric surgery
Medicare covers some bariatric surgical procedures, like gastric bypass surgery and laparoscopic banding surgery, when you meet certain conditions related to morbid obesity.

Second surgical opinions
Medicare covers a second surgical opinion in some cases for medically necessary surgery that isn’t an emergency. In some cases, Medicare covers third surgical opinions. You pay 20% of the Medicare-approved amount. The Part B deductible applies.

Blood
If the provider gets blood from a blood bank at no charge, you won’t have to pay for it or replace it. However, you’ll pay a copayment for the blood processing and handling services for each unit of blood you get. The Part B deductible applies. If the provider has to buy blood for you, you must either pay the provider costs for the first 3 units of blood you get in a calendar year, or you or someone else can donate the blood.

Laboratory tests
Medicare covers medically necessary clinical diagnostic laboratory tests when your doctor or provider orders them. These tests may include certain blood tests, urinalysis, certain tests on tissue specimens, and some screening tests. You generally pay nothing for these tests..

Tests (Non-laboratory)
Medicare covers X-rays, MRIs, CT scans, EKG/ECGs, and some other diagnostic tests. You pay 20% of the Medicare-approved amount. The Part B deductible applies.

If you get the test at a hospital as an outpatient, you also pay the hospital a copayment that may be more than 20% of the Medicare-approved amount. In most cases, this amount can’t be more than the Part A hospital stay deductible. Go to “Laboratory tests” on page 45 for other Part B-covered tests.

Electrocardiogram (EKG or ECG) screenings
Medicare covers a routine EKG/ECG screening if you get a referral from your doctor or other healthcare provider during your one-time “Welcome to Medicare” (See Preventive Services – Welcome to Medicare). After you meet the Part B deductible, you pay 20% of the Medicare-approved amount. Medicare also covers EKGs or ECGs as diagnostic tests (See Tests (Non-laboratory)). You also pay a copayment if you have the test at a hospital or a hospital-owned clinic.

Defibrillators
Medicare may cover an implantable automatic defibrillator if you’ve been diagnosed with heart failure. If the surgery takes place in an outpatient setting, you pay 20% of the Medicare-approved amount for your doctors’ services. You also pay a copayment. In most cases, the copayment can’t be more than the Part A hospital stay deductible. The Part B deductible applies. Part A covers surgeries to implant defibrillators in an inpatient hospital setting. (See Medicare Part A – Inpatient hospital care)

Cardiac rehabilitation
Medicare covers comprehensive programs that include exercise, education, and counseling if you’ve had at least one of these conditions:

  • A heart attack in the last 12 months
  • Coronary artery bypass surgery
  • Current stable angina pectoris (chest pain)
  • A heart valve repair or replacement
  • A coronary angioplasty (a medical procedure used to open a blocked artery) or coronary stenting (a procedure used to keep an artery open)
  • A heart or heart-lung transplant
  • Stable chronic heart failure

Medicare covers regular and intensive cardiac rehabilitation programs. Medicare covers services in a doctor’s office or hospital outpatient setting. You pay 20% of the Medicare-approved amount if you get the services in a doctor’s office, and a copayment in a hospital outpatient setting. The Part B deductible applies

Chemotherapy
Medicare covers chemotherapy in a doctor’s office, freestanding clinic, or hospital outpatient setting if you have cancer. You pay a copayment for chemotherapy in a hospital outpatient setting. You pay 20% of the Medicare-approved amount for chemotherapy in a doctor’s office or freestanding clinic. The Part B deductible applies.

For chemotherapy in an inpatient hospital setting covered under Part A (See Medicare Part A – Inpatient hospital care)

Clinical research studies
Clinical research studies test how well different types of medical care work and if they’re safe, like how well a cancer drug works. Medicare covers some costs, like office visits and tests in certain qualifying clinical research studies. You may pay 20% of the Medicare-approved amount, depending on the treatment you get. The Part B deductible may apply.

Kidney (renal) dialysis services & supplies
Generally, Medicare covers 3 dialysis treatments (or equivalent continuous ambulatory peritoneal dialysis) per week if you have End-Stage Renal Disease (ESRD). This includes most renal dialysis drugs and biological products, and all laboratory tests, home dialysis training, support services, equipment, and supplies. The dialysis facility is responsible for coordinating your dialysis services (at home or in a facility). You pay 20% of the Medicare-approved amount. The Part B deductible applies.

Kidney disease education
Medicare covers up to 6 sessions of kidney disease education services if you have Stage IV chronic kidney disease that will usually require dialysis or a kidney transplant, and your doctor or other health care provider refers you for the service. You pay 20% of the Medicare-approved amount per session if you get the service from a doctor or other qualified health care provider. The Part B deductible applies.

Diabetes equipment, supplies, & therapeutic shoes
Medicare covers meters and continuous glucose monitors that measure blood glucose (blood sugar) and related supplies, including test strips, lancets, lancet holders, sensors, and control solutions. Medicare also covers tubing, insertion sets, and insulin for patients using insulin pumps, and sensors, transmitters, and receivers for patients using continuous glucose monitors. In addition, Medicare covers one pair of extra-depth or custom shoes and inserts per year for people with specific diabetes-related foot problems.

You pay 20% of the Medicare-approved amount if your supplier accepts assignment. The Part B deductible applies.

Note: Medicare drug coverage (Part D) may cover insulin, certain medical supplies used to inject insulin (like syringes), disposable pumps, and some oral diabetes drugs. Check with your plan for more information. The cost of a one-month supply of each covered insulin product is capped at $35. See Medicare Part D (Similar caps on costs apply for traditional insulin used in insulin pumps covered under Part B).

Surgical dressing services
Medicare covers medically necessary treatment of a surgical or surgically treated wound. You pay nothing for the supplies and 20% of the Medicare-approved amount for your doctor or other health care provider services. You pay a set copayment for these services when you get them in a hospital outpatient setting. The Part B deductible applies.

Drugs
Part B covers a limited number of outpatient prescription drugs, like:

  • Injections you get in a doctor’s office
  • Certain oral anti-cancer drugs
  • Drugs used with some types of durable medical equipment (like a nebulizer or external infusion pump)
  • Intravenous Immune Globulin for use in the home
  • Certain drugs you get in a hospital outpatient setting (under very limited circumstances)

Note: Other than the examples above, you pay 100% for most drugs, unless you have Medicare drug coverage (Part D) or other drug coverage. (See Medicare Part D)

For some drugs used with an external infusion pump and for Intravenous Immune Globulin for use in the home, Medicare may also cover services (like nursing visits) under the home infusion therapy benefit and the Intravenous Immune Globulin benefit (See Home infusion therapy services & supplies). Part B also covers some injectable or implantable drugs to treat substance use disorder when a provider administers it in a doctor’s office or a hospital as an outpatient. You pay 20% of the Medicare-approved amount for these drugs. The Part B deductible applies. You won’t have to pay any copayments for these services if you get them from a Medicare-enrolled opioid treatment program (See Opioid use disorder treatment services).

Doctors and pharmacies must accept assignment for Part B-covered drugs, so you should never be asked to pay more than the coinsurance or copayment for the Part B drug itself.

Note: Your coinsurance can change depending on your prescription drug’s price. You might pay a lower coinsurance for certain drugs and biologicals covered by Part B that you get in a doctor’s office or pharmacy, or in a hospital outpatient setting, if their prices have increased higher than the rate of inflation. The specific drugs and potential savings change every quarter.

If the Part B-covered drugs you get in a hospital outpatient setting are part of your outpatient services, you pay a copayment for the services. Part B doesn’t cover “self-administered drugs” in a hospital outpatient setting. “Self-administered drugs” are drugs you’d normally take on your own.

What you pay for self-administered drugs in an outpatient hospital setting depends on whether you have Medicare drug coverage (Part D) or other drug coverage, and whether the hospital’s pharmacy is in your drug plan’s network. If you have other drug coverage, your drug plan may cover drugs that Part B may not cover. Contact your drug plan to find out what you pay for drugs you get in a hospital outpatient setting that Part B doesn’t cover.

Shots (or vaccines)
Part B covers (See Preventive Service):

  • Flu shot
  • Hepatitis B shots
  • Pneumococcal shots
  • Coronavirus disease 2019 (COVID-19) vaccine.

Medicare drug coverage (Part D) generally covers all other recommended adult immunizations to prevent illness (like shingles, tetanus, diphteria, pertussis, and respiratory syncytial virus (RSV)) at no cost to you. If the shot isn’t on your plan’s drug list yet, you can ask for a coverage exception or get reimbursed. Contact your plan for details, and talk to your doctor or other health care provider about which vaccines are right for you.

Transplants & immunosuppressive drugs
Medicare covers doctor services for heart, lung, kidney, pancreas, intestine, and liver transplants under certain conditions, but only in Medicare-certified facilities. Medicare also covers bone marrow and cornea transplants under certain conditions.

Medicare covers immunosuppressive drugs if Medicare paid for the transplant. You must have Part A at the time of the covered transplant, and you must have Part B at the time you get immunosuppressive drugs (or qualify for the immunosuppressive drug benefit described below). You pay 20% of the Medicare-approved amount for the drugs. The Part B deductible applies. Keep in mind, Medicare drug coverage (Part D) covers immunosuppressive drugs if Part B doesn’t cover them.

Note: Medicare may cover transplant surgery under Medicare Part A hospital inpatient service 

Medicare pays the full cost of care for your kidney donor. You and your donor won’t have to pay a deductible, coinsurance, or any other costs for their hospital stay.

Durable medical equipment (DME)
Medicare covers medically necessary items like oxygen and oxygen equipment, wheelchairs, walkers, and hospital beds when a Medicare-enrolled doctor or other health care provider orders for use in the home. You must rent most items, but you can also buy them. Some items become your property after you’ve made a number of rental payments. You pay 20% of the Medicare-approved amount. The Part B deductible applies.

Make sure your doctors and DME suppliers are enrolled in Medicare. It’s important to ask your suppliers if they participate in Medicare before you get DME. If suppliers are participating suppliers, they must accept assignment (which means, they can charge you only the coinsurance and Part B deductible for the Medicare-approved amount). If DME suppliers aren’t participating and don’t accept assignment, there’s no limit on the amount they can charge you.

Home infusion therapy services & supplies
Medicare covers equipment and supplies (like pumps, IV poles, tubing, and catheters) for home infusion therapy to administer certain IV infusion drugs, like Intravenous Immune Globulin, at home. Medicare covers certain equipment and supplies (like the infusion pump) and the infusion drug under Durable Medical Equipment (see above – (DME)). Medicare also covers services (like nursing visits), training for caregivers, and patient monitoring. You pay 20% of the Medicare-approved amount for these services and for the equipment and supplies you use in your home.

Eyeglasses
Medicare covers one pair of eyeglasses with standard frames (or one set of contact lenses) after each cataract surgery that implants an intraocular lens. Medicare will only pay for contact lenses or eyeglasses from a supplier enrolled in Medicare, no matter if you or your provider submits the claim. After you meet the Part B deductible, you pay 20% of the Medicare-approved amount for corrective lenses after cataract surgery with an intraocular lens.

Foot care
Medicare covers yearly foot exams or treatment if you have diabetes-related lower leg nerve damage that can increase the risk of limb loss or need medically necessary treatment for foot injuries or diseases, like hammer toe, bunion deformities, and heel spurs. You pay 20% of the Medicare-approved amount for medically necessary treatment your doctor approves. The Part B deductible applies. You also pay a copayment for medically necessary treatment in a hospital outpatient setting.

Lymphedema compression treatment items
If you’ve been diagnosed with lymphedema, Medicare will cover your prescribed gradient compression garments (standard and custom fitted). You pay 20% of the Medicare-approved amount. The Part B deductible applies.

Prosthetic/orthotic items
Medicare covers these prosthetics/orthotics when a Medicare-enrolled doctor or other health care provider orders them: arm, leg, back, and neck braces; artificial eyes; artificial limbs (and their replacement parts); and prosthetic devices needed to replace an internal body organ or function of the organ (including ostomy supplies, parenteral and enteral nutrition therapy, and some types of breast prostheses after a mastectomy).

For Medicare to cover your prosthetic or orthotic, you must go to a supplier that’s enrolled in Medicare. You pay 20% of the Medicare-approved amount. The Part B deductible applies.

Hearing & balance exams
Medicare covers these diagnostic exams if your doctor or health care provider orders them to see if you need medical treatment.

You can visit an audiologist once every 12 months without an order from a doctor or other health care provider, but only for non-acute hearing conditions (like hearing loss that occurs over many years) and for diagnostic services related to hearing loss that’s treated with surgically implanted hearing devices.

You pay 20% of the Medicare-approved amount. The Part B deductible applies. You also pay a copayment in a hospital outpatient setting.

Note: Medicare doesn’t cover hearing aids or exams for fitting hearing aids.

Transitional care management services
Medicare may cover this service if you’re returning to your community after a stay at certain facilities, like a hospital or skilled nursing facility. The healthcare provider who’s managing your transition back into the community will work with you and your caregiver to coordinate and manage your care for the first 30 days after you return home. The Part B deductible and coinsurance apply. Visit Medicare.gov/coverage/transitional-care-management-services to learn more.

Home health services
Medicare covers home health services under Part A and/or Part B. Medicare covers medically necessary part-time or intermittent skilled nursing care, physical therapy, speech-language pathology services, or continued occupational therapy services. Home health services may also include medical social services, part-time or intermittent home health aide services, durable medical equipment, and medical supplies for use at home. “Part-time or intermittent” means you may be able to get skilled nursing care and home health aide services if they are provided less than 8 hours each day or less than 28 hours each week (or up to 35 hours a week in some limited situations). A doctor or other health care provider (like a nurse practitioner) must assess you face-to-face before certifying that you need home health services. A doctor or health care provider must order your care, and a Medicare-certified home health agency must provide it.

Medicare covers home health services as long as you need part-time or intermittent skilled services and as long as you’re “homebound,” which means:

  • You have trouble leaving your home without help (like using a cane, wheelchair, walker, or crutches; special transportation; or help from another person) because of an illness or injury.
  • Leaving your home isn’t recommended because of your condition.
  • You’re normally unable to leave your home because it’s a major effort.

You pay nothing for covered home health services. However, for Medicare-covered durable medical equipment, you pay 20% of the Medicare-approved amount. The Part B deductible applies.

Preventive Service

“Welcome to Medicare” preventive visit
During the first 12 months that you have Part B, you can get a “Welcome to Medicare” preventive visit. The visit includes a review of your medical and social history related to your health. It also includes education and counseling about preventive services, including certain screenings, shots or vaccines (like f lu, pneumococcal, and other recommended shots or vaccines), and referrals for other care, if needed. When you make your appointment, let your doctor’s office know that you would like to schedule your “Welcome to Medicare” preventive visit. You pay nothing for the “Welcome to Medicare” preventive visit if the doctor or other qualified health care provider accepts assignment. If you have a current prescription for opioids, your provider will review your potential risk factors for opioid use disorder, evaluate your severity of pain and current treatment plan, provide information on non-opioid treatment options, and may refer you to a specialist, if appropriate. Your provider will also review your potential risk factors for substance use disorder, like alcohol and tobacco use, and refer you for treatment, if needed.

Note: If your doctor or other health care provider performs additional tests or services during the same visit that Medicare doesn’t cover under this preventive benefit, you may have to pay coinsurance, and the Part B deductible may apply. If Medicare doesn’t cover the additional tests or services (like a routine physical exam), you may have to pay the full amount.

Yearly “Wellness” visit
If you’ve had Part B for longer than 12 months, you can get a yearly “Wellness” visit to develop or update your personalized plan to prevent disease or disability based on your current health and risk factors. The yearly “Wellness” visit isn’t a physical exam. Medicare covers this visit once every 12 months.

Your doctor or health care practitioner will ask you to fill out a questionnaire, called a “Health Risk Assessment,” as part of this visit. Answering these questions can help you and your doctor develop a personalized prevention plan to help you stay healthy and get the most out of your visit. Your visit may include routine measurements, health advice, a review of your medical and family history, your current prescriptions, advance care planning, and more.

Your doctor or health care practitioner will also perform a cognitive assessment to look for signs of dementia, including Alzheimer’s disease. Signs of cognitive impairment include trouble remembering, learning new things, concentrating, managing finances, and making decisions about your everyday life. If your doctor or health care practitioner thinks you may have cognitive impairment, Medicare covers a separate visit to do a more thorough review of your cognitive function and check for conditions like dementia, depression, anxiety, or delirium and design a care plan.

Your doctor or health care practitioner will also evaluate your potential risk factors for a substance use disorder and refer you for treatment, if needed. If you use opioid medication, your provider will review your pain treatment plan, share information about non-opioid treatment options, and refer you to a specialist, as appropriate.

Note: Your first yearly “Wellness” visit can’t take place within 12 months of your Part B enrollment or your “Welcome to Medicare” preventive visit. However, you don’t need to have had a “Welcome to Medicare” preventive visit to qualify for a yearly “Wellness” visit.

You pay nothing for the yearly “Wellness” visit if the doctor or health care practitioner accepts assignment.

If your doctor or health care practitioner performs additional tests or services during your “Wellness” visit that Medicare doesn’t cover under this preventive benefit, you may have to pay a coinsurance, and the Part B deductible may apply. If Medicare doesn’t cover the additional tests or services (like a routine physical exam), you may have to pay the full amount.

Abdominal aortic aneurysm screenings
Medicare covers an abdominal aortic aneurysm screening ultrasound once if you’re at risk (only with a referral from your doctor or other qualified health care provider). You’re considered at risk if you have a family history of abdominal aortic aneurysms, or you’re a man 65–75 and have smoked at least 100 cigarettes in your lifetime. You pay nothing for the screening if your doctor or other qualified health care provider accepts assignment.

Alcohol misuse screenings & counseling
Medicare covers an alcohol misuse screening for adults (including pregnant individuals) who use alcohol, but don’t meet the medical criteria for alcohol dependency. If your primary care doctor or other health care provider determines you’re misusing alcohol, you can get up to 4 brief, face-toface counseling sessions per year (if you’re competent and alert during counseling). You must get counseling in a primary care setting, like a doctor’s office. You pay nothing if your primary care doctor or other health care provider accepts assignment.

Advance care planning
Medicare covers voluntary advance care planning as part of your yearly “Wellness” visit . This is planning for care you would get when you need help making decisions for yourself. As part of advance care planning, you may choose to complete an advance directive. This is an important legal document that records your wishes about medical treatment in the future if you aren’t able to make decisions about your care. You can talk about an advance directive with your healthcare provider, and they can help you fill out the forms if you prefer.

Consider carefully who you want to speak for you and what directions you want to give. You have the right to carry out your plans as you choose without discrimination based on your age or disability. You can update your advance directive at any time. You pay nothing if it’s given as part of the yearly “Wellness” visit, and your doctor or other qualified healthcare provider accepts assignment.

Medicare may also cover this service as part of your medical treatment. When advance care planning isn’t part of your yearly “Wellness” visit, the Part B deductible and coinsurance apply.

Bone mass measurements
This test helps to see if you’re at risk for broken bones. Medicare covers it once every 24 months (more often if medically necessary) for people who have certain medical conditions or meet certain criteria. You pay nothing for this test if your doctor or other qualified health care provider accepts assignment.

Cardiovascular behavioral therapy
Medicare covers a cardiovascular behavioral therapy visit one time each year with your primary care doctor or other qualified primary care practitioner in a primary care setting (like a doctor’s office) to help lower your risk for cardiovascular disease. During this visit, your doctor may discuss aspirin use (if appropriate), check your blood pressure, and give you tips on eating well. You pay nothing if your primary care doctor or other health care provider accepts assignment.

Cardiovascular disease screenings
These screenings include blood tests for cholesterol, lipid, and triglyceride levels that help detect conditions that may lead to a heart attack or stroke. Medicare covers these screening blood tests once every 5 years. You pay nothing for the tests if the doctor or other qualified health care provider accepts assignment.

Cervical & vaginal cancer screenings
Medicare covers Pap tests and pelvic exams to check for cervical and vaginal cancers. As part of the pelvic exam, Medicare also covers a clinical breast exam to check for breast cancer. Medicare covers these screening tests once every 24 months in most cases. Medicare covers these screening tests once every 12 months if you’re at high risk for cervical or vaginal cancer, or if you’re of child-bearing age and had an abnormal Pap test in the past 36 months.

Medicare also covers Human Papillomavirus (HPV) tests (as part of a Pap test) once every 5 years if you’re 30–65 without HPV symptoms.

You pay nothing for the lab Pap test, the lab HPV with the Pap test, the Pap test specimen collection, and pelvic and breast exams if your doctor or other qualified health care provider accepts assignment.

Colorectal cancer screenings
Medicare covers these screenings to help find precancerous growths or find cancer early when treatment is most effective. Medicare may cover one or more of these screening tests:

  • Barium enema: Medicare covers this test once every 48 months if you’re 45 or older (or every 24 months if you’re high risk) when your doctor uses it instead of a flexible sigmoidoscopy or screening colonoscopy. You pay 20% of the Medicare-approved amount for your doctors’ services. In a hospital outpatient setting, you also pay the hospital a copayment. The Part B deductible doesn’t apply.
  • Screening Colonoscopies: Medicare covers this screening test once every 120 months (or every 24 months if you’re high risk) or 48 months after a previous flexible sigmoidoscopy. There’s no minimum age requirement. If you initially have a non-invasive stool-based screening test (fecal occult blood tests or multi-target stool DNA test) and receive a positive result, Medicare also covers a follow-up colonoscopy as a screening test. You pay nothing for the screening test(s) if your doctor or other qualified health care practitioner accepts assignment.
  • Flexible sigmoidoscopies: Medicare covers this test once every 48 months if you’re 45 or older or 120 months after a previous screening colonoscopy if you aren’t at high risk. You pay nothing for the test if your doctor or other qualified health care practitioner accepts assignment. If your doctor finds and removes a polyp or other tissue during the colonoscopy or flexible sigmoidoscopy, you pay 15% of the Medicare-approved amount for your doctors’ services. In a hospital outpatient setting, you also pay the hospital a 15% coinsurance. The Part B deductible doesn’t apply.
  • Fecal occult blood tests: Medicare covers this screening test once every 12 months if you’re 45 or older. You pay nothing for the test if your doctor or other qualified health care practitioner accepts assignment.
  • Multi-target stool DNA & blood-based biomarker tests: Medicare covers these screening tests once every 3 years if you meet all of these conditions:
    • You’re between 45–85.
    • You show no symptoms of colorectal disease, including but not limited to lower gastrointestinal pain, blood in stool, and a positive guaiac fecal occult blood test or fecal immunochemical test.
    • You’re at average risk for developing colorectal cancer, meaning:
      • You have no personal history of adenomatous polyps, colorectal cancer, or inflammatory bowel disease, including Crohn’s Disease and ulcerative colitis.
      • You have no family history of colorectal cancer or adenomatous polyps, familial adenomatous polyposis, or hereditary nonpolyposis colorectal cancer.

Multi-target stool DNA tests are at-home lab tests. Blood-based biomarker tests are conducted in a lab. You pay nothing for these tests if your doctor or other qualified health care practitioner accepts assignment.

Counseling to prevent tobacco use & tobacco-caused disease
Medicare covers up to 8 face-to-face visits in a 12-month period if you use tobacco. You pay nothing for the counseling sessions if your doctor or other qualified health practitioner accepts assignment.

COVID-19 Vaccines:

  • FDA-approved and FDA-authorized vaccines help reduce the risk of illness from COVID-19 by working with the body’s natural defenses to safely develop immunity (protection) against the virus.
  • You pay nothing for the COVID-19 vaccine.
  • Be sure to bring your red, white, and blue Medicare card with you when you get the vaccine so your health care provider or pharmacy can bill Medicare. If you’re in a Medicare Advantage Plan, you must use the card from your plan to get your Medicare-covered services and, like other covered services, your plan may require that you get the vaccine from an in-network provider. If you’re in a Medicare Advantage Plan, you pay nothing when you get the vaccine from an in-network provider.

Depression screening
Medicare covers one depression screening per year. The screening must be done in a primary care setting (like a doctor’s office) that can provide follow-up treatment and/or referrals. You pay nothing for this screening if your doctor accepts assignment.

If you or someone you know is struggling or in crisis and would like to talk to a trained crisis counselor, call or text 988, the free and confidential Suicide & Crisis Lifeline. You can also connect with a counselor through web chat at 988lifeline.org.

Diabetes screenings
Medicare covers up to 2 blood glucose (blood sugar) laboratory test screenings (with and without a carbohydrate challenge) each year if your doctor determines you’re at risk for developing diabetes. You pay nothing for the test if your doctor or other qualified health care practitioner accepts assignment.

Diabetes self-management training
Medicare covers diabetes outpatient self-management training to teach you to cope with and manage your diabetes. The program may include tips for eating healthy, being active, monitoring blood glucose (blood sugar), taking prescription drugs, and reducing risks. You must have been diagnosed with diabetes and have a written order from your doctor or other health care provider. Some patients may also be eligible for medical nutrition therapy services. You pay 20% of the Medicare-approved amount. The Part B deductible applies

Flu shots
Medicare covers the seasonal flu shot (or vaccine). You pay nothing (and the Part B deductible doesn’t apply) for the flu shot if the doctor or other qualified health care provider accepts assignment for giving the shot.

Glaucoma screenings
Medicare covers this screening once every 12 months if you’re at high risk for the eye disease glaucoma. You’re at high risk if you have diabetes, a family history of glaucoma, are African American and 50 or older, or are Hispanic and 65 or older. An eye doctor who’s legally allowed to do glaucoma screenings in your state must do or supervise the screening. You pay 20% of the Medicare-approved amount. The Part B deductible applies. You also pay a copayment in a hospital outpatient setting.

Hepatitis B shots
Medicare covers these shots (or vaccines) if you’re at medium or high risk for Hepatitis B. Some risk factors include hemophilia, End-Stage Renal Disease (ESRD), diabetes, if you live with someone who has Hepatitis B, or if you’re a health care worker and have frequent contact with blood or body fluids. Check with your doctor to find out if you’re at medium or high risk for Hepatitis B. You pay nothing for the shot if the doctor or other qualified health care provider accepts assignment.

Hepatitis B Virus infection screenings
Medicare covers Hepatitis B Virus infection screenings only if your doctor orders it. Medicare also covers the screenings:

  • Yearly, only if you’re at continued high risk and don’t get a Hepatitis B shot.
  • If you’re pregnant:
    • At the first prenatal visit for each pregnancy
    • At the time of delivery for those with new or continued risk factors
    • At the first prenatal visit for future pregnancies, even if you previously got the Hepatitis B shot or had negative Hepatitis B Virus screening results

You pay nothing for the screening test if the doctor or health care practitioner accepts assignment.

Hepatitis C screenings
Medicare covers one Hepatitis C screening test if you meet one of these conditions:

  • You’re at high risk because you use or have used illicit injection drugs.
  • You had a blood transfusion before 1992.
  • You were born between 1945 and 1965.

Medicare also covers yearly repeat screenings if you’re at high risk.

Medicare will only cover a Hepatitis C screening test if your healthcare provider orders one. You pay nothing for the screening test if your primary care doctor or other qualified health care provider accepts assignment.

HIV (Human Immunodeficiency Virus) screenings
Medicare covers HIV screenings once every 12 months if you’re:

  • Between 15–65.
  • Younger than 15 or older than 65, and at increased risk.

Medicare also covers this test up to 3 times during a pregnancy.

You pay nothing for the HIV screening if your doctor or other qualified health care provider accepts assignment.

Lung cancer screenings
Medicare covers lung cancer screenings with low-dose computed tomography once per year if you meet these conditions:

  • You’re 50–77.
  • You don’t have signs or symptoms of lung cancer (you’re asymptomatic).
  • You’re either a current smoker, or you quit smoking within the last 15 years.
  • You have a tobacco smoking history of at least 20 “pack years” (an average of one pack—20 cigarettes—per day for 20 years).
  • You get an order from your doctor.

You pay nothing for this service if your doctor accepts assignment.

Before your first lung cancer screening, you’ll need to schedule an appointment with a healthcare provider to discuss the benefits and risks of lung cancer screening to decide if the screening is right for you.

Mammograms
Medicare covers a mammogram screening to check for breast cancer once every 12 months if you’re a woman 40 or older. Medicare covers one baseline mammogram if you’re a woman between 35 and 39. You pay nothing for the test if the doctor or other qualified healthcare provider accepts assignment.

Part B also covers diagnostic mammograms more frequently than once a year when medically necessary. You pay 20% of the Medicare-approved amount for diagnostic mammograms. The Part B deductible applies.

Note: Medicare covers medically necessary breast ultrasounds only when your doctor or provider orders them.

Medical nutrition therapy services
Medicare covers medical nutrition therapy services if you have diabetes or kidney disease or if you’ve had a kidney transplant in the last 36 months and a doctor refers you for services. Only a Registered Dietitian or nutrition professional who meets certain requirements can provide medical nutrition therapy services. If you have diabetes, you may also be eligible for diabetes self-management training. You pay nothing for medical nutrition therapy preventive services because the deductible and coinsurance don’t apply.

Medicare Diabetes Prevention Program
Medicare covers a once-per-lifetime health behavior change program to help you prevent type 2 diabetes. The program begins with weekly core sessions offered in a group setting over a 6-month period. Once you complete the core sessions, you’ll get 6 monthly follow-up sessions to help you maintain healthy habits. If you started the Medicare Diabetes Prevention Program in 2021 or earlier, you’ll get an additional 12 monthly sessions if you meet certain weight loss goals.

You can get these services from an approved Medicare Diabetes Prevention Program supplier. These suppliers may be traditional healthcare providers or organizations like community centers or faith-based organizations. To find a supplier or learn more about the program, visit Medicare.gov/coverage/ medicare-diabetes-prevention-program.

Obesity behavioral therapy
If you have a body mass index (BMI) of 30 or more, Medicare covers obesity screenings and behavioral counseling to help you lose weight by focusing on diet and exercise. Medicare covers this counseling if your primary care doctor or other primary care practitioner gives the counseling in a primary care setting (like a doctor’s office), where they can coordinate your personalized prevention plan with your other care. You pay nothing for this service if your primary care doctor or other provider accepts assignment.

Pneumococcal shots
Medicare covers pneumococcal shots (or vaccines) to help prevent pneumococcal infections (like certain types of pneumonia). Talk with your doctor or other health care provider about this vaccine. You pay nothing for these shots if the provider accepts assignment for giving the shots.

Prostate cancer screenings
Medicare covers digital rectal exams and prostate-specific antigen (PSA) tests once every 12 months for men over 50 (starting the day after your 50th birthday). For the digital rectal exam, you pay 20% of the Medicare-approved amount. The Part B deductible applies. You also pay a copayment in a hospital outpatient setting. You pay nothing for the PSA test.

Sexually transmitted infection (STI) screenings & counseling
Medicare covers STI screenings for chlamydia, gonorrhea, syphilis, and/or Hepatitis B. Medicare covers these screenings if you’re pregnant or at increased risk for an STI when your primary care doctor or other health care provider orders the tests. Medicare covers these tests once every 12 months or at certain times during pregnancy.

Medicare also covers up to 2 individual, 20–30 minute, face-to-face, high-intensity behavioral counseling sessions each year if you’re a sexually active adult at increased risk for STIs. Medicare will only cover these counseling sessions with a primary care doctor or health care practitioner in a primary care setting (like a doctor’s office). Medicare won’t cover counseling as a preventive service in an inpatient setting, like a skilled nursing facility.

You pay nothing for these services if your primary care doctor or practitioner accepts assignment.

COVID-19 (Coronavirus disease 2019)
Many people with Medicare are at higher risk for serious COVID-19 illness, so it’s important to take the necessary steps to keep yourself and others safe.

Medicare covers several tests, items, and services related to COVID-19. Talk with your doctor or health care provider to find out which are right for you:

COVID-19 Vaccines:

  • See under Preventive Services COVID-19 Vaccines)

Diagnostic laboratory tests:

  • These FDA-authorized tests check to see if you have COVID-19.
  • You pay nothing when a health care provider orders this test and the test is performed by a laboratory (including at a pharmacy, clinic or doctor’s office), or hospital that takes Medicare. If you’re in a Medicare Advantage Plan, you pay nothing when you get this test from an in-network provider.

Monoclonal antibody treatments and products:

  • These FDA-authorized treatments can help fight the disease and keep you out of the hospital, if you test positive for COVID-19 and have mild to moderate symptoms.
  • You pay nothing for this treatment when you get it from a Medicare provider or supplier. You must meet certain conditions to qualify. If you’re in a Medicare Advantage Plan, you pay nothing when you get these treatments from an in-network provider.
  • Original Medicare will cover monoclonal antibody treatments if you have COVID-19 symptoms.

Note: Certain monoclonal antibody products can protect you before you’re exposed to COVID-19. If you have Part B and your doctor decides this type of product could work for you (like if you have a weakened immune system), you pay nothing for the product when you get it from a Medicare provider or supplier.

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