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Is Medicare Part B Coverage Enough for Me?


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Medicare Part B (medical insurance) is part of Original Medicare, along with Medicare Part A (hospital insurance). You may be wondering if Part B gives you all the coverage you need.

What does Medicare Part B cover?

Medicare Part B may cover a wide range of outpatient medical care such as:

  • Doctor visits
  • Preventive care
  • Flu shots
  • Certain screenings, like colonoscopies and mammograms
  • Lab tests and x-rays
  • Limited, short-term home health care
  • Ambulance services (in some cases).

Medicare Part B may also cover some medical services delivered in an outpatient hospital setting, such as surgeries, diagnostic imaging, medical supplies, dialysis for failing kidneys, and chemotherapy for cancer. This is not a complete list of what Part B may cover.

Many services under Part B come with cost-sharing that you have to pay, such as coinsurance or copayments. A deductible may apply to many services.

Medicare Part B generally doesn’t cover inpatient hospital care, inpatient rehabilitation, or skilled nursing facility stays—all of which are expensive types of care.

How Medicare Part A coverage works alongside Medicare Part B insurance

The good news is that if you are eligible for Medicare Part B coverage, you usually qualify for Part A coverage, too. Medicare Part A generally covers inpatient hospitalizations and physical rehabilitation, skilled nursing facility care, and limited home health services.

And unlike Medicare Part B coverage, Medicare Part A is available to many people at no premium cost. You do not pay a monthly premium for Medicare Part A coverage if you (or your spouse) have paid Medicare taxes for at least 10 years while working. Even if you are not eligible for premium-free Part A, you may be able to get Part A coverage by paying a monthly premium. It’s worthwhile to have Medicare Part A alongside Medicare Part B coverage to help pay for the complex, expensive care associated with hospital, rehab and skilled nursing stays.

Like Medicare Part B, Part A services typically require you to pay deductibles and coinsurance or copayments.

You’ll need both Medicare Part A and Medicare Part B to get the full benefits available under Medicare for medical care.

Medicare Part B coverage: Medicare Supplement (Medigap) insurance plans can fill in the gaps

Typically Medicare Part B pays 80% for most covered services after you have met your annual deductible. You also usually pay copayments or coinsurance.

A Medicare Supplement insurance plan may cover your Medicare Part B (and Part A) out-of-pocket costs. Private insurance companies sell Medicare Supplement insurance plans. Medicare Supplement plans have various standardized benefits, which means that you can choose the Medicare Supplement plan type that best matches your needs. You must have Medicare Part A and Part B to purchase a Medicare Supplement plan.

Does Medicare Part B include prescription drug coverage?

Medicare Part B doesn’t cover most prescription drugs you take at home. Part B may cover certain medications administered to you in a clinic. Medicare Part A may cover medications given to you as part of your inpatient treatment.

Unless you have prescription drug coverage from another source, such as a spouse’s employer-sponsored group health plan, you may want to enroll in a Medicare Part D prescription drug plan when you enroll in Medicare Part B to cover most prescription drugs you take at home. By enrolling in a Medicare Prescription Drug Plan when you are first eligible for Medicare or when you lose your creditable prescription drug coverage, you may be able to avoid a late enrollment penalty.

You can research Medicare plan options available where you live by simply entering your zip code in the box on this page and clicking the button. If you want personalized help, call us to speak with a licensed eHealth insurance agent who is knowledgeable about Medicare.

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