Medicare Part B – Coverage, Exclusions, and Preventive Services

Medicare Part B is the medical coverage that helps cover medically-necessary services like doctors’ services, outpatient care, home health services, and other medical services. Part B also covers some preventive services. Some of the most commonly used medical services covered by Part B are listed below:

    Ambulance Services

    Ambulatory Surgical Centers

    Blood (the first 3 units of blood are not covered)

    Chiropractic Services (limited)

    Clinical Laboratory Service

    Diabetes Supplies (note: insulin and certain medical supplies used to inject insulin)

    Doctor Services

    Durable Medical Equipment (like walkers)

    EKG Screening

    Emergency Department Services

    Home Health Services (covers only medically necessary services; you pay nothing)

    Kidney Dialysis Services and Supplies

    Mental Health Care

    Non-doctor Services (such as physician assistants, nurse practitioners, social workers, physical therapists, and psychologists)

    Occupational Therapy

    Outpatient Medical and Surgical Services and Supplies

    Physical Therapy (there may be limits on these services and exceptions)

    Prosthetic/Orthotic Items

    Second Surgical Opinions (in some cases, Medicare covers third surgical opinions)

    Surgical Dressing Services

    Tests (other than lab tests, such as x-rays, MRIs, CT scans, EKGs, and some other diagnostic    tests)

    Transplants and Immunosuppressive Drugs

 

Medicare Part B does have certain exclusions. Here are some of the more common ones:

 

Cosmetic surgery, unless particular medical conditions render it necessary

Procedures considered experimental

Hearing aids and fittings

Chiropractic services, except for treatment of subluxation (partial dislocation) of the spine

Most eyeglasses and eye exams (except following cataract surgery that implants an intraocular lens)

Most dentures and dental care

Prescription drugs

Over-the-counter drugs

 

Part B coverage also offers coverage for preventive services. Some of the most common preventive services are the following:

    Abdominal Aortic Aneurysm Screen (one-time ultrasound for people at risk.)

    Bone Mass Measurement/Bone Density (once every 24 months)

    Cardiovascular Screenings (every 5 years to test cholesterol, lipid, and triglyceride levels)

    Colorectal Cancer Screenings

    Diabetes Screenings (covered if you have certain risk factors)

    Diabetes Self-Management Training (for people with diabetes)

    Flu shot (one per flu season)

    Glaucoma Tests (once every 12 months for those at high risk)

    Hepatitis B Shots (covered for people at high or medium risk)

    HIV Screening (covered for people at any age who ask for the test, pregnant women)

    Mammograms – Screening (once every 12 months for women age 40+)

    Pap Tests and Pelvic Exams, including clinical breast exam (once every 24 months, or once every 12 months for women at high risk)

    Physical Exam – “Welcome to Medicare” exam and yearly “wellness” exams

    Pneumococcal Shot (covered once in your lifetime)

    Prostate Cancer Screenings (once every 12 months for men over age 50)

    Smoking Cessation (up to 8 visits during a 12 month period)

 

Sources used for this article:

 

http://www.kff.org/medicare/7067/ataglance.cfm

https://www.cms.gov/MedicareGenInfo/

http://www.medicare.org/medicare-basics/part-b.html

 

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