October 2, 2017
What Does Medicare Part B Cover?
Medicare Part B covers many different types of tests, items, and services that are medically necessary or that help prevent diseases or conditions. The problem is there’s an enormous amount of fine print. Many things are covered only under certain circumstances or up to certain dollar amounts.
Also take into account that Medicare pays about 80% of these costs, so you’re never 100% insured.
Only a Medicare Supplement will fully insure you.
If you don’t see your need on this list, ask your doctor if it’s covered under Medicare.
- Advance Care Planning
- Air-fluidized beds & other support surfaces
- Air transportation
- Ambulance services
- Only when other transportation could endanger your health
- Only to nearest appropriate medical facility that’s able to give you the care you need
- Ambulatory surgical centers
- Anesthesia
- Artificial eyes & limbs
- Bariatric surgery
- Only certain procedures like gastric bypass surgery and laparoscopic banding surgery
- Must meet certain conditions related to morbid obesity
- Blood
- Blood processing & handling
- Blood sugar (glucose) monitors
- Blood sugar (glucose) test strips
- Bone mass measurement (bone density)
- Covered once every 2 years for those meeting the following criteria:
- A woman whose doctor determines she's estrogen deficient and at risk for osteoporosis, based on her medical history and other findings
- A person whose X-rays show possible osteoporosis, osteopenia, or vertebral fractures
- A person taking prednisone or steroid-type drugs or is planning to begin this treatment
- A person who has been diagnosed with primary hyperparathyroidism
- A person who is being monitored to see if their osteoporosis drug therapy is working
- Covered once every 2 years for those meeting the following criteria:
- Braces (arm, leg, back, and neck)
- Breast prostheses
- After a mastectomy only
- Breast reconstruction surgery is also covered
- Canes
- White canes for the blind are not covered
- Cardiac rehabilitation programs
- Must be referred by doctor and have had any of the following:
- A heart attack in the last 12 months
- Coronary artery bypass surgery
- Current stable angina pectoris
- A heart valve repair or replacement
- A coronary angioplasty or coronary stent
- A heart or heart-lung transplant
- Stable chronic heart failure
- Cardiovascular disease (behavioral therapy)
- One visit per year
- Cataract surgery
- Chemotherapy
- Chiropractic services
- Manual manipulation of the spine only if it’s medically necessary to correct a subluxation when provided by a chiropractor
- Chronic care management services
- If you have 2 or more serious chronic conditions that are expected to last at least a year
- Clinical research studies
- Commode chairs
- Continuous passive motion (CPM) machine
- Cosmetic surgery
- Only if it’s needed because of injury or to improve the function of a malformed body part
- Crutches
- Defibrillator (implantable automatic)
- Diabetes self-management training
- Diagnostic tests
- CT scans
- MRIs
- EKGs
- X-rays
- PET scans
- Dialysis (children)
- Dialysis (kidney) services & supplies
- Doctor & other health care provider services
- Covers preventative tests provided in an office setting, hospital, skilled nursing facility, or your home
- Drugs
- Used with an item of durable medical equipment, like an infusion pump or drugs given by a nebulizer
- Some antigens
- Injectable osteoporosis drugs
- Erythropoiesis-stimulating agents
- Blood clotting factors
- Injectable and infused drugs
- Oral End-Stage Renal Disease drugs
- Parenteral and enteral nutrition (intravenous and tube feeding)
- Intravenous Immune Globulin provided in the home
- Vaccinations (flu, pneumococcal, Hepatitis B, and shots for vaccines directly related to the treatment of an injury or illness)
- Transplant drugs
- Oral cancer drugs
- Oral anti-nausea drugs
- Self-administered drugs in hospital outpatient settings
- Durable medical equipment (DME) coverage
- Emergency department services
- Enteral nutrition supplies & equipment (feeding pump)
- Eye exams
- Not routine eye exams; only some preventative and diagnostic eye exams
- Eyeglasses/contact lenses
- Only following cataract surgery that implants an intraocular lens, and only one pair of glasses or one set of contact lenses
- Federally qualified health center services
- Flu shots
- One flu shot per season
- Foot care
- No routine foot care; only podiatrist services for medically necessary treatment of foot injuries or diseases (hammer toes, bunion deformities, and heel spurs)
- Foot exam
- 1 foot exam every 6 months as long as you haven’t seen a foot care professional for another reason between visits
- Glaucoma tests
- Once every 12 months for those with a high risk for glaucoma
- Glucose control solutions
- Health education & wellness programs
- Medical nutrition therapy if you have diabetes or kidney disease
- Kidney disease education services
- Diabetes education if you have diabetes
- Counseling to stop smoking and tobacco use
- Alcohol misuse counseling
- A one-time “Welcome to Medicare” preventive visit
- A yearly “wellness” visit
- Must be referred by doctor and have had any of the following:
- Only if your doctor or other health care provider orders these tests to see if you need medical treatment
- Only when medically necessary
- Only if you have these conditions:
- Acute carbon monoxide intoxication
- Decompression illness
- Gas embolism
- Gas gangrene
- Acute traumatic peripheral ischemia
- Crush injuries and suturing of severed limbs
- Progressive necrotizing infections
- Acute peripheral arterial insufficiency
- Preparation and preservation of compromised skin grafts
- Chronic refractory osteomyelitis, unresponsive to conventional medical and surgical management
- Osteoradionecrosis as an adjunct to conventional treatment
- Soft tissue radionecrosis as an adjunct to conventional treatment
- Cyanide poisoning
- Actinomycosis, only as an adjunct to conventional therapy when the disease process is refractory to antibiotics and surgical treatment
- Infusion pumps & supplies
- Kidney transplants (adults and children)
- Doctors' services for kidney transplant surgery (including care before surgery, the actual surgery, and care after surgery)
- Doctors' services for your kidney donor during their hospital stay
- Transplant drugs also called immunosuppressive drugs (for a limited time after you leave the hospital following a transplant)
- Blood (whole or units of packed red blood cells, blood components, and the cost of processing and giving you blood)
- Laboratory services (clinical)
- Certain blood tests
- Urinalysis
- Tests on tissue specimens
- Some screening tests
- Lancet devices & lancets
- Macular degeneration
- Mammograms
- Once every 12 months or when medically necessary
- Manual wheelchairs & power mobility devices
- Mental health care
- Nebulizers & nebulizer medications
- Nutrition therapy services (medical)
- An initial nutrition and lifestyle assessment
- One-on-one nutritional counseling
- Follow-up visits to check on your progress in managing your diet
- Orthotics, artificial limbs, & eyes
- Ostomy supplies
- Oxygen equipment & accessories
- Covers rental of oxygen equipment and accessories
- If you own the equipment, oxygen contents and supplies are covered if:
- Your doctor says you have a severe lung disease or you’re not getting enough oxygen
- Your health might improve with oxygen therapy
- Your arterial blood gas level falls within a certain range
- Other alternative measures have failed
- Pancreas transplants (adults)
- If you have End-Stage Renal Disease and it’s done at the same time or after you get a kidney transplant
- Patient lifts
- Physical therapy/occupational therapy/speech-language pathology services
- There are therapy cap limits that change each year
- Preventive & screening services
- Abdominal aortic aneurysm screening (must get referral from doctor)
- Alcohol misuse screenings & counseling
- Bone mass measurements (bone density)
- Cardiovascular disease screenings
- Cardiovascular disease (behavioral therapy)
- Cervical & vaginal cancer screening
- Colorectal cancer screenings
- Depression screenings
- Diabetes screenings
- Diabetes self-management training
- EKG screening
- Glaucoma tests
- Hepatitis C screening test
- HIV screening
- Lung cancer screening
- Mammograms (screening)
- Nutrition therapy services
- Obesity screenings & counseling
- Prostate cancer screenings
- Sexually transmitted infections screening & counseling
- Pulmonary rehabilitation program
- Radiation therapy
- Rural health clinic services
- Second surgical opinions
- Only if the surgery isn’t an emergency
- A third opinion is covered if the first and second opinions are different
- Sleep apnea & Continuous Positive Airway Pressure (CPAP) devices & accessories
- 3-month trial of CPAP therapy is covered if you’ve been diagnosed with obstructive sleep apnea
- Sleep study
- Type I, II, III, and IV sleep tests and devices
- Suction pumps
- Surgery (estimating costs)
- Surgical dressing services
- Telehealth
- Therapeutic shoes or inserts
- Covers furnishing and fitting of either one custom-molded pair or one extra-depth pair of shoes each year
- Traction equipment
- Transitional care management services
- Transplants (adults)
- Urgently needed care
- Walkers
- X-rays
- Yearly eye exam
- For diabetic retinopathy only
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