Medicare Part B helps cover medical services like doctors' services, outpatient care, and other medical services that Part A doesn't cover. Part B is optional. Part B helps pay for covered medical services and items when they are medically necessary. Part B also covers some preventive services like exams, lab tests, and screening shots to help prevent, find, or manage a medical problem.

Cost: If you have Part B, you pay a Part B premium each month. Most people will pay the standard premium amount. Social Security will contact some people who have to pay more depending on their income. If you don't sign up for Part B when you are first eligible, you may have to pay a late enrollment penalty.

For more information about enrolling in Medicare, look in your copy of the "Medicare & You" handbook, call Social Security at 1-800-772-1213, or visit your local Social Security office. If you get benefits from the Railroad Retirement Board (RRB), call your local RRB office or 1-800-808-0772.

Medicare Part B (Medical Insurance) covers a “Welcome to Medicare” preventive visit once within the first 12 months you have Part B.

Your costs in Original Medicare

You pay nothing for the visit if your doctor or other health care provider accepts assignment. The Part B  deductible doesn’t apply. However, you may have to pay coinsurance, and the Part B deductible may apply 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. If Medicare doesn't cover the additional tests or services (like a routine physical exam), you may have to pay the full amount.

Note

Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. Ask questions so you understand why your doctor is recommending certain services and if, or how much, Medicare will pay for them.

What it is

This visit includes a review of your medical and social history related to your health. It also includes education and counseling about preventive services, including these:

• Certain screenings, flu and pneumococcal shots, and referrals for other care, if needed.
• Height, weight, and blood pressure measurements.
• A calculation of your body mass index.
• A simple vision test.
• A review of your potential risk for depression and your level of safety.
• An offer to talk with you about creating advance directives.
• A written plan letting you know which screenings, shots, and other preventive services you need. Get details about coverage for screenings, shots, and other preventive services.

Things to know

When you make your appointment, let your doctor’s office know you would like to schedule your “Welcome to Medicare” preventive visit. Bring the following to your appointment:

• Medical records, including immunization records.
• Family health history.
• A list of any prescription drugs, over-the-counter drugs, vitamins, and supplements that you currently take, how often you take them, and why.

Note

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.

Medicare Part B (Medical Insurance) covers up to 12 acupuncture visits in 90 days for chronic low back pain.

Medicare covers an additional 8 sessions if you show improvement. If you aren't showing improvement, Medicare won't cover your additional treatments and they should be discontinued. You can get a maximum of 20 acupuncture treatments in a 12-month period.

Note

Not all providers can give acupuncture, and Medicare can't directly pay Licensed Acupuncturists for their services. Medicare also doesn't cover acupuncture (including dry needling) for any condition other than chronic low back pain.

Your costs in Original Medicare

After you meet the Part B deductible, you pay 20% of the Medicare-approved amount.

What it is

Acupuncture is a technique where providers stimulate specific points on the body, most often by inserting thin needles through the skin.

Things to know

Chronic low back pain is defined as:

• Lasting 12 weeks or longer
• Not having a known cause (for example, not related to cancer that has spread, or an infectious or inflammatory disease)
• Pain that isn't associated with surgery or pregnancy

You must get acupuncture from a doctor, or by another health care provider (like a nurse practitioner or physician assistant) who has both of these:

• A masters or doctoral level degree in acupuncture or Oriental Medicine from a school accredited by the Accreditation Commission on Acupuncture and Oriental Medicine
• A current, full, active, and unrestricted license to practice acupuncture in the state where you're getting care

Medicare Part B (Medical Insurance) 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 primary care provider determines you’re misusing alcohol, you can get up to 4 brief face-to-face counseling sessions each year (if you’re competent and alert during counseling).

How often

Medicare covers an alcohol misuse screening once each year.

Your costs in Original Medicare

You pay nothing, if your primary care doctor or other primary care provider accepts  assignment.  

Note

Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. Ask questions so you understand why your doctor is recommending certain services and if, or how much, Medicare will pay for them.

Things to know

A primary care doctor or other primary care provide must provide counseling in a primary care setting (like a doctor’s office).

Medicare Part B (Medical Insurance) covers blood glucose (blood sugar) monitors as durable medical equipment (DME) that your doctor prescribes for use in your home.

Your costs in Original Medicare

After you meet the Part B Deductible, you pay 20% of the Medicare-Approved Amount (if your supplier accepts assignment). Medicare pays for different kinds of DME in different ways. Depending on the type of equipment:

• You may need to rent the equipment.
• You may need to buy the equipment.
• You may be able to choose whether to rent or buy the equipment.

Medicare will only cover your DME if your doctors and DME suppliers are enrolled in Medicare. Doctors and suppliers have to meet strict standards to enroll and stay enrolled in Medicare. If your doctors or suppliers aren’t enrolled, Medicare won’t pay the claims they submit. 

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

Things to know

Note

To find out how much your test, item, or service will cost, talk to your doctor or health care provider. The specific amount you’ll owe may depend on several things, like:

• Other insurance you may have
• How much your doctor charges
• If your doctor accepts assignment
• The type of facility
• Where you get your test, item, or service

Medicare Part B (Medical Insurance) covers cardiovascular screening blood tests once every 5 years. 

Your costs in Original Medicare

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

Note

Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. Ask questions so you understand why your doctor is recommending certain services and if, or how much, Medicare will pay for them.

What it is

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 chemotherapy if you have cancer. Medicare Part A (Hospital Insurance) covers it if you're a hospital inpatient. Medicare Part B (Medical Insurance) covers it if you’re a hospital outpatient or a patient in a doctor’s office or freestanding clinic.

Your costs in Original Medicare

You pay a copayment for chemotherapy covered under Part B in a hospital outpatient setting. For chemotherapy given in a doctor's office or freestanding clinic, you pay 20% of the  Medicare-Approved Amount, and the Part B deductible applies.

Note

Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. Ask questions so you understand why your doctor is recommending certain services and if, or how much, Medicare will pay for them.

Note

To find out how much your test, item, or service will cost, talk to your doctor or health care provider. The specific amount you’ll owe may depend on several things, like:

• Other insurance you may have
• How much your doctor charges
• If your doctor accepts assignment
• The type of facility
• Where you get your test, item, or service

Medicare covers screening colonoscopies once every 24 months if you’re at high risk for colorectal cancer. If you aren’t at high risk, Medicare covers the test once every 120 months, 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.

Your costs in Original Medicare

If your doctor or other health care provider accepts assignment, you pay nothing for the screening test(s). However, if your doctor finds and removes a polyp or other tissue during the colonoscopy, you pay 15% of the Medicare-Approved Amount for your doctors' services. In a hospital outpatient setting or ambulatory surgical center, you also pay the facility a 15% coinsurance amount. The Part B deductible doesn't apply. 

Note

To find out how much your test, item, or service will cost, talk to your doctor or health care provider. The specific amount you’ll owe may depend on several things, like:

• Other insurance you may have
• How much your doctor charges
• If your doctor accepts assignment
• The type of facility
• Where you get your test, item, or service

Note

Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. Ask questions so you understand why your doctor is recommending certain services and if, or how much, Medicare will pay for them.

What it is

Tests to help find precancerous growths or find cancer early, when treatment is most effective.

Medicare Part B (Medical Insurance) covers one depression screening per year. 

If you or someone you know is struggling or in crisis, call or text 988, the free and confidential Suicide & Crisis Lifeline. You can call and speak with a trained crisis counselor 24 hours a day, 7 days a week. You can also connect with a counselor through web chat at 988lifeline.org.

Call 911 if you're in immediate medical crisis.

Your costs in Original Medicare

If your doctor accepts assignment, you pay nothing for the screening. Your screening must occur in a primary care setting (like a doctor's office) that can provide follow-up treatment and/or referrals.

Note

Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. Ask questions so you understand why your doctor is recommending certain services and if, or how much, Medicare will pay for them.

Medicare Part B (Medical Insurance) covers blood glucose (blood sugar) laboratory test screenings (with or without a carbohydrate challenge) if your doctor determines you’re at risk for developing diabetes. You may be eligible for up to 2 screenings each year. Part B covers these screenings if you have any of these risk factors:

• High blood pressure (hypertension)
• History of abnormal cholesterol and triglyceride levels (dyslipidemia)
• Obesity
• History of high blood sugar 

Part B also covers these screenings if 2 or more of these conditions apply to you:

• You’re 65 or older.
• You’re overweight.
• You have a family history of diabetes (parents or siblings).
• You have a history of gestational diabetes (diabetes during pregnancy) or delivery of a baby weighing more than 9 pounds.

Your costs in Original Medicare

You pay nothing for these screenings if your doctor or other health care provider accepts assignment.

Medicare Part B (Medical Insurance) covers medically necessarydoctor services (including outpatient services and some doctor services you get when you’re a hospital inpatient) and covered preventive services.

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

Your costs in Original Medicare

You pay 20% of the Medicare-Approved Amountfor most services. You pay nothing for certain preventive services if your doctor or other provider accepts assignment . The Part B deductibleapplies. 

Note

To find out how much your test, item, or service will cost, talk to your doctor or health care provider. The specific amount you’ll owe may depend on several things, like:

• Other insurance you may have
• How much your doctor charges
• If your doctor accepts assignment
• The type of facility
• Where you get your test, item, or service

Things to know

A doctor can be one of these:

• Doctor of Medicine (MD)
• Doctor of Osteopathic Medicine (DO)
• In some cases, a dentist, podiatrist (foot doctor), optometrist (eye doctor), or Doctor of Chiropractic (DC)

Medicare also covers services you get from other health care providers, like:

• Clinical nurse specialists
• Clinical psychologists 
• Clinical social workers
• Nurse practitioners
• Occupational therapists 
• Physician assistants
• Physical therapists
• Speech-language pathologists

Medicare Part B (Medical Insurance) covers E-visits with your doctors and certain other health care providers.

Your costs in Original Medicare

After you meet the Part B deductible, you pay 20% of the 

Medicare Part B (Medical Insurance) usually covers emergency department services when you have an injury, a sudden illness, or an illness that quickly gets much worse.

Your costs in Original Medicare

• You pay a copayment  for each emergency department visit and a copayment for each hospital service you get.
• After you meet the Part B deductible , you also pay 20% of the Medicare-Approved Amount  for your doctor's services.
• If your doctor admits you to the same hospital for a related condition within 3 days of your emergency department visit, you don't pay the copayment(s) because your visit is considered part of your inpatient stay.  

Note

To find out how much your test, item, or service will cost, talk to your doctor or health care provider. The specific amount you’ll owe may depend on several things, like:

• Other insurance you may have
• How much your doctor charges
• If your doctor accepts assignment
• The type of facility
• Where you get your test, item, or service

Things to know

Medicare only covers emergency services in foreign countries under rare circumstances.

Medicare Part B (Medical Insurance) covers the seasonal flu shot (or vaccine) once per flu season.

Your costs in Original Medicare

You pay nothing for a flu shot if your doctor or other qualified health care provider accepts assignment for giving the shot.

Things to know

• Don’t wait to get the flu shot. You can get the flu shot many places, including your doctor’s office and your local pharmacy — contact them for details. If you have a Medicare Advantage Plan, contact your plan — most places accept Medicare Advantage Plans.
• Stay safe. Your doctors and pharmacies are working hard to keep you safe and socially distanced. Remember to wear your mask when you get your shot.
• It’s safe to get the flu shot with other vaccines, so protect yourself against COVID-19 by getting your COVID-19 vaccine at the same time as your flu shot.

Note

Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. Ask questions so you understand why your doctor is recommending certain services and if, or how much, Medicare will pay for them.

Medicare Part B (Medical Insurance) covers glaucoma tests once every 12 months if you’re at high risk for developing the eye disease glaucoma. You’re considered at high risk if at least one of these conditions applies to you:

• You have diabetes
• You have a family history of glaucoma
• You’re African American and age 50 or older
• You’re Hispanic and age 65 or older

Your costs in Original Medicare

• After you meet the Part B deductible, you pay 20% of the Medicare-Approved Amount.
• In a hospital outpatient setting, you also pay a copayment .

Note

To find out how much your test, item, or service will cost, talk to your doctor or health care provider. The specific amount you’ll owe may depend on several things, like:

• Other insurance you may have
• How much your doctor charges
• If your doctor accepts assignment
• The type of facility
• Where you get your test, item, or service

Note

Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. Ask questions so you understand why your doctor is recommending certain services and if, or how much, Medicare will pay for them.

Medicare Part B (Medical Insurance) covers diagnostic hearing and balance exams if your doctor or other health care provider orders them to find out if you need medical treatment. 

You can also see an audiologist once every 12 months without an order from your doctor or other health care provider, but only for:

• Non-acute hearing conditions (like hearing loss that occurs over many years)
• Diagnostic services related to hearing loss that’s treated with surgically implanted hearing devices

Your costs in Original Medicare

• After you meet the Part B deductible, you pay 20% of the Medicare-Approved Amount.
• In a hospital outpatient setting, you also pay the hospital a copayment.

Note

To find out how much your test, item, or service will cost, talk to your doctor or health care provider. The specific amount you’ll owe may depend on several things, like:

• Other insurance you may have
• How much your doctor charges
• If your doctor accepts assignment
• The type of facility
• Where you get your test, item, or service

Note

Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. Ask questions so you understand why your doctor is recommending certain services and if, or how much, Medicare will pay for them.

Things to know

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

Medicare Part B (Medical Insurance) covers insulin if you use an insulin pump that's covered under Part B's durable medical equipment benefit. Part B doesn’t cover insulin pens or insulin-related supplies like:

• Syringes
• Needles
• Alcohol swabs
• Gauze

Part D covers these:

• Injectable insulin that isn’t used with a traditional insulin pump
• Insulin used with a disposable insulin pump
• Certain medical supplies used to inject insulin, like syringes, gauze, and alcohol swabs

Your costs in Original Medicare

• The cost of a one-month supply of each Part D-covered insulin is capped at $35, and you don’t have to pay a deductible for insulin. If you get a 3-month supply of insulin, your costs can't be more than $35 for each month's supply of each covered insulin. This means you'll generally pay no more than $105 for a 3-month supply of covered insulin.
• Under Part D, the $35 cap applies to everyone who takes insulin, even if you get Extra Help.
• If you have Part B and Medicare supplement Insurance (Medigap) that pays your Part B coinsurance, your plan should cover the $35 (or less) cost for insulin.
• For insulin-related supplies (like syringes, needles, alcohol swabs and gauze), you'll pay 100% of the cost under Part B (unless you have Part D).

Note

To find out how much your test, item, or service will cost, talk to your doctor or health care provider. The specific amount you’ll owe may depend on several things, like:

• Other insurance you may have
• How much your doctor charges
• If your doctor accepts assignment
• The type of facility
• Where you get your test, item, or service

Things to know

If you use an insulin pump that isn’t disposable, Part B may cover insulin used with the pump and cover the pump itself as durable medical equipment (DME). If you live in certain areas of the country, you may have to use specific insulin pump suppliers for Medicare to pay for a durable insulin pump.

Medicare Part B (Medical Insurance) covers medical nutrition therapy services if you have diabetes or kidney disease, or you’ve had a kidney transplant in the last 36 months, and your doctor refers you for services.

Your costs in Original Medicare

You pay nothing for these preventive services if you qualify to get them.

Your doctor may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn't cover. If this happens, you may have to pay some or all of the costs. Ask questions so you understand why your doctor is recommending certain services and if, or how much, Medicare will pay for them.

What it is

Services may include:

• An initial nutrition and lifestyle assessment
• Individual and/or group nutritional therapy services
• Help managing the lifestyle factors that affect your diabetes
• Follow-up visits to check on your progress in managing your diet

Things to know

Only a Registered Dietitian (or nutrition professional who meets certain requirements) can provide medical nutrition therapy services.

If you get dialysis in a dialysis facility, Medicare covers medical nutrition therapy as part of your overall dialysis care.

If you’re in a rural area, you may be able to get medical nutrition therapy via telehealth from a Registered Dietitian or other nutritional professional in a different location.

If you have diabetes, you may also be eligible for diabetes self-management training.

If you have a body mass index (BMI) of 30 or more, Medicare Part B (Medical Insurance) covers obesity screenings and behavioral counseling. Medicare covers this counseling if your primary care doctor or other primary care provider 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.  

Your costs in Original Medicare

You pay nothing for this service if your primary care doctor or other primary care provider accepts assignment.

Note

Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. Ask questions so you understand why your doctor is recommending certain services and if, or how much, Medicare will pay for them.

What it is

An initial screening for BMI, and behavioral therapy sessions that include a dietary assessment and counseling to help you lose weight by focusing on diet and exercise.

Medicare Part B (Medical Insurance) covers prosthetic devices needed to replace a body part or function when a Medicare-enrolled doctor or other health care provider orders them.

Examples of prosthetic devices include:

• Breast prostheses (including a surgical bra).
• One pair of conventional eyeglasses or contact lenses provided after a cataract operation.
• Ostomy bags and certain related supplies.
• Some surgically implanted prosthetic devices, including cochlear implants.
• Urological supplies.

Your costs in Original Medicare

After you meet the Part B deductible, you pay 20% of the Medicare-Approved Amount for external prosthetic devices.

Some states may require prior authorization for certain types of lower-limb prosthetics before Medicare will pay.

To find out how much your test, item, or service will cost, talk to your doctor or health care provider. The specific amount you’ll owe may depend on several things, like:

• Other insurance you may have
• How much your doctor charges
• If your doctor accepts assignment
• The type of facility
• Where you get your test, item, or service

Things to know

For Medicare to pay for your prosthetic device, you must go to a Medicare-enrolled supplier. This is true no matter who submits the claim (you or the provider). Either Part A or Part B covers a surgically implanted prosthetic device depending on if the surgery takes place in an inpatient or outpatient setting.

Medicare Part B (Medical Insurance) covers walkers, including rollators, as durable medical equipment (DME). The walker must be medically necessary, and your doctor or other treating provider must prescribe it for use in your home.

Your costs in Original Medicare

After you meet the Part B Deductible, you pay 20% of the Medicare-Approved Amount (if your supplier accepts assignment). Medicare pays for different kinds of DME in different ways. Depending on the type of equipment:

• You may need to rent the equipment.
• You may need to buy the equipment.
• You may be able to choose whether to rent or buy the equipment.

Medicare will only cover your DME if your doctors and DME suppliers are enrolled in Medicare. Doctors and suppliers have to meet strict standards to enroll and stay enrolled in Medicare. If your doctors or suppliers aren’t enrolled, Medicare won’t pay the claims they submit. 

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

You can use any Medicare-approved supplier to make repairs to a walker that you currently own. This includes replacement of parts needed for the repair.

Note

To find out how much your test, item, or service will cost, talk to your doctor or health care provider. The specific amount you’ll owe may depend on several things, like:

• Other insurance you may have
• How much your doctor charges
• If your doctor accepts assignment
• The type of facility
• Where you get your test, item, or service

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

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.

Your costs in Original Medicare

You pay nothing for this visit if your doctor or other health care provider accepts assignment.

The Part B deductible doesn’t apply. 

However, you may have to pay coinsurance, and the Part B deductible may apply 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.

If Medicare doesn't cover the additional tests or services (like a routine physical exam), you may have to pay the full amount.

What it is

Your provider 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 provider develop a personalized prevention plan to help you stay healthy and get the most out of your visit. Your visit may include:

• Routine measurements (like height, weight, and blood pressure).
• A review of your medical and family history.
• A review of your current prescriptions.
• Personalized health advice.
• Advance care planning.

Your provider 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 provider 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.

Note

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 and refer you for treatment, if needed.