For Consumers

What Medicare Part B (medical insurance) covers

Medicare Part B covers two 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.
  • 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 (also referred to as assignment).  

Other Part B covered services or items:


Find out if Medicare covers your item, service or supply (www.medicare.gov).

How much is covered?

ServicesBenefitMedicare pays in 2019You pay in 2019Medicare pays in 2018You pay in 2018

Medical expenses

  • Doctor services

  • Inpatient and outpatient medical and surgical services, and supplies

  • Physical and speech therapy

  • Diagnostic tests

  • Durable medical equipment and other services

Unlimited, if medically necessary

80% of approved amount (after $185 deductible)

 

$185 deductible,* plus 20% of approved amount and limited charges above approved amount**

80% of approved amount (after $183 deductible)

 

$183 deductible,* plus 20% of approved amount and limited charges above approved amount**

Clinical laboratory tests
Blood test, urinalysis and more

Unlimited, if medically necessary

Generally 100% of approved amount

Nothing for services

Generally 100% of approved amount

Nothing for services

Home Health Care
Part-time or intermittent skilled care, home health aide services, durable medical equipment and supplies, and other services

Unlimited, as long as you meet Medicare requirements

100% of approved amount; 80% of approved amount for durable medical equipment

Nothing for services; 20% of approved amount* for durable medical equipment

100% of approved amount; 80% of approved amount for durable medical equipment

Nothing for services; 20% of approved amount* for durable medical equipment

Outpatient hospital treatment
Services for the diagnosis or treatment of an illness or injury

Unlimited, if medically necessary

Medicare payment to hospital based on hospital costs

20% of billed amount*

Medicare payment to hospital based on hospital costs

20% of billed amount*

Blood
When furnished by a hospital or skilled nursing facility during a covered stay

Unlimited during a benefit period if medically necessary

80% of approved amount (after $185 deductible and starting with the fourth pint)

For first three pints plus 20% of approved amount for additional pints***

80% of approved amount (after $183 deductible and starting with the fourth pint)

For first three pints plus 20% of approved amount for additional pints***

* After you pay the yearly deductible of $185 in 2019 or $183 in 2018, you typically pay 20% of the Medicare-approved amount for most doctor services, outpatient therapy and durable medical equipment for the rest of the year.

** Federal law limits charges for physician services.

*** If the hospital gets blood from a blood bank at no charge, you won't pay for replacing it. If the hospital buys blood for you, you must either pay the hospital costs for the first three units of blood you get in a calendar year or have the blood donated by you or someone else.

Monthly Part B premium: The standard Part B premium amount in  2019 is $135.50 or in 2018 is $134 (or higher depending on your income). However, about 3.5% of people who get Social Security benefits will pay less due to the “hold harmless” provision. Social Security will tell you the exact amount you’ll pay. For more information, go to Part B costs (www.medicare.gov).