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Medicare Part B Helps Cover . . .


Denotes preventive services
This symbol identifies the preventive services in the Part B coverage charts below.



Ambulance Services When you need to be transported to a hospital or skilled nursing facility, and transportation in any other vehicle would endanger your health.
Ambulatory Surgery Center Facility fees are covered for approved services.
Blood Pints of blood you get as an outpatient or as part of a Part B-covered service.
Bone Mass Measurement Denotes preventive servicesTo help see if you are at risk for broken bones. This service is covered once every 24 months (more often if medically necessary) for people with Medicare who meet certain medical conditions.
Cardiovascular Screenings Denotes preventive servicesEvery five years to test your cholesterol, lipid, and triglyceride levels to help prevent a heart attack or stroke.
Chiropractic Services (limited) To correct a subluxation (when one or more of the bones of your spine moves out of position) using manipulation of the spine.
Clinical Laboratory Services Including blood tests, urinalysis, some screening tests, and more.
Clinical Trials To help doctors and researchers find better ways to prevent, diagnose, or treat diseases. Clinical trials test new types of medical care, like how well a new cancer drug works. Routine costs are covered if you take part in a qualifying clinical trial (may not cover the costs of experimental care, such as the drugs or devices being tested in a clinical trial).
Colorectal Cancer Screenings To help find precancerous growths, and help prevent or find cancer Cancer early, when treatment is most effective. One or more of the following Screenings tests may be covered. Talk to your doctor.
  1. Fecal Occult Blood Test--Once every 12 months if age 50 or older. You pay nothing for the test, but usually have to pay for the doctor visit.
  2. Flexible Sigmoidoscopy--Generally, once every 48 months if age 50 or older, or every 120 months when used instead of a colonoscopy for those not at high risk.>
  3. Screening Colonoscopy--Once every 120 months (high risk every 24 months). No minimum age.
  4. Barium Enema--Once every 48 months if age 50 or older (high risk every 24 months) when used instead of sigmoidoscopy or colonoscopy.
Your risk for colorectal cancer increases if you or a close relative have had colorectal polyps or cancer, or if you have inflammatory bowel disease (like Crohn's disease). In 2007, Medicare covers its share of these costs even if you haven't met the yearly Part B Deductible.
Diabetes Screenings To check for diabetes. These screenings are covered if you have any of the following risk factors: high blood pressure (hypertension), dyslipidemia (history of abnormal cholesterol and triglyceride levels), obesity, or a history of high blood sugar. Tests are covered if you answer yes to two or more of the following questions.
  • Are you age 65 or older?
  • Are you overweight?
  • Do you have a family history of diabetes (parents, brothers, sisters)?
  • Do you have a history of gestational diabetes (diabetes during pregnancy), or did you deliver a baby weighing more than 9 pounds?
Based on the results of these tests, you may be eligible for up to two diabetes screenings every year.
Diabetic Self-management Training For people with diabetes. Your doctor or other health care provider must provide a written order.
Diabetic Supplies Including glucose testing monitors, blood glucose test strips, lancet devices and lancets, glucose control solutions, and therapeutic shoes (in some cases). Syringes and insulin are only covered if used with an insulin pump or if you have Medicare prescription drug coverage.
Doctor Services Doesn't cover routine physical exams except for the one-time "Welcome to Medicare" Physical Exam (see page 17).
Durable Medical Equipment Items such as oxygen, wheelchairs, walkers, and hospital beds needed for use in the home.
Emergency Room Services When you believe your health is in serious danger, when every second counts. You may have a bad injury, sudden illness, or an illness that quickly gets much worse.
Eye Exams For people with diabetes to check for diabetic retinopathy once every 12 months.
Eyeglasses (limited) One pair of eyeglasses with standard frames after cataract surgery that implants an intraocular lens.
Flu Shots Denotes preventive servicesTo help prevent influenza or flu virus. This is covered once a flu season in the fall or winter. The flu is a serious illness. You need a flu shot for the current virus each year.
Foot Exams and Treatment If you have diabetes-related nerve damage and/or meet certain conditions.
Glaucoma Tests Denotes preventive servicesTo help find the eye disease glaucoma. This is covered once every 12 months for people at high risk for glaucoma. You are considered high risk for glaucoma if you have diabetes, a family history of glaucoma, are African American and age 50 or older, or are Hispanic and age 65 or older. Tests must be done by an eye doctor legally authorized to perform this service in your state.
Hearing and Balance Exam If your doctor orders it to see if medical treatment is needed. Hearing aids and exams for fitting hearing aids aren't covered.
Hepatitis B Shots Denotes preventive servicesTo help protect people from getting Hepatitis B. This is covered (three shots) for people with Medicare at high or medium (intermediate) risk for Hepatitis B. Your risk for Hepatitis B increases if you have hemophilia, End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant), or a condition that lowers your resistance to infection. Other factors may increase your risk for Hepatitis B. Check with your doctor to see if you are at high or medium risk for Hepatitis B.
Home Health Services Limited to reasonable and necessary part-time or intermittent skilled nursing care and home health aide services as well as physical therapy, occupational therapy, and speech-language pathology that are ordered by your doctor and provided by a Medicare-certified home health agency. Also includes medical social services, other services, durable medical equipment (such as wheelchairs, hospital beds, oxygen, and walkers), and medical supplies for use at home.
Kidney Dialysis Services and Supplies Either in a facility or at home.
Mammograms (screening) Denotes preventive servicesTo check women for breast cancer before they or their doctor may be able to feel it. Preventive (screening) mammograms are covered once every 12 months for all women with Medicare age 40 and older. Medicare covers one baseline mammogram for women between age 35 and 39.
Medical Nutrition Therapy Services Medicare may cover medical nutrition therapy if you have diabetes or kidney disease and you are referred for the service by your doctor.
Mental Health Care (outpatient) Certain limits and conditions apply.
Occupational Therapy Services given to help you return to usual activities (such as bathing) after an illness.
Outpatient Hospital Services Received as an outpatient as part of a doctor's care.
Outpatient Medical and Surgical Services and Supplies For approved procedures.
Pap Test and Pelvic Exam (includes clinical breast exam) Denotes preventive servicesTo check for cervical and vaginal cancers. Medicare covers these exams for women at low risk for cervical cancer every 24 months. These exams are covered once every 12 months for women at high risk for cervical and vaginal cancer, and those of child bearing age who have had an exam that indicated cancer or other abnormalities in the past three years. Your risk of developing breast cancer increases if you had breast cancer in the past, have a family history of breast cancer (like a mother, sister, daughter, or two or more close relatives who have had breast cancer), had your first baby after age 30, or have never had a baby.
Physical Exam (one-time "Welcome to Medicare" Physical Exam) Denotes preventive servicesA one-time review of your health, and education and counseling about Preventive Services, including certain screenings and shots. Getting referrals for other care, if you need it, are also covered. Important: You must have the physical exam within the first six months you have Medicare Part B, and Deductibles and Coinsurance apply.
Physical Therapy Treatment of injuries and disease by mechanical means, such as heat, light, exercise, and massage.
Pneumococcal Shot Denotes preventive servicesTo help prevent pneumococcal infections. Most people only need this preventive shot once in their lifetime. Talk with your doctor.
Practitioner Services Such as those provided by clinical social workers, physician assistants, and nurse practitioners.
Prescription Drugs Limited, like certain injectable cancer drugs. For information about additional Medicare prescription drug coverage (Part D), see pages 43 - 56.
Prostate Cancer Screening Denotes preventive servicesThese tests help find prostate cancer. Medicare covers a preventive digital rectal exam and Prostate Specific Antigen (PSA) test once every 12 months for all men with Medicare over age 50.
Prosthetic/ Orthotic Items Including arm, leg, back, and neck braces; artificial eyes; artificial limbs (and their replacement parts); breast prostheses (after mastectomy); prosthetic devices needed to replace an internal body part or function (including ostomy supplies and parenteral and enteral nutrition therapy).
Second Surgical Opinions Covered in some cases (and some third surgical opinions are covered) for surgery that isn't an emergency.
Smoking Cessation (counseling to stop smoking) Denotes preventive servicesProvided at any provider site if ordered by your doctor. It includes up to eight face-to-face visits during a 12-month period if you are diagnosed with a smoking-related illness or are taking medicine that may be affected by tobacco.
Speech-language Pathology Services Treatment given to regain and strengthen speech skills.
Surgical Dressings For treatment of a surgical or surgically treated wound.
Telemedicine Services in some rural areas, under certain conditions in a practitioner's office, a hospital, or a federally-qualified health center.
Tests Including X-rays, MRIs, CT scans, EKGs, and some other diagnostic tests.
Transplant Services Including heart, lung, kidney, pancreas, intestine, and liver transplants under certain conditions and in a Medicare-certified facility only. Bone marrow and cornea transplants (under certain conditions). Immunosuppressive drugs are covered if the transplant was paid for by Medicare, or paid by an employer or union group health plan that was required to pay before Medicare (you must have been entitled to Medicare Part A at the time of the transplant and entitled to Medicare Part B at the time you get immunosuppressive drugs, and the transplant must have been performed in a Medicare-certified facility).

Note: Medicare drug plans may cover immunosuppressive drugs, even if the transplant wasn't paid for by Medicare or an employer or union group health plan.
Travel (health care needed when traveling outside the United States) Limited to medical services provided in Canada when you travel on the most direct route through Canada between Alaska and another state. Medicare also covers hospital, ambulance, and doctor services if you are in the United States, but the nearest hospital that can treat you isn't in the United States (the "United States" means the 50 states, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa). In some cases, Medicare may pay for services that you get while on board a ship within the territorial waters adjoining the land areas of the United States.
Urgently Needed Care To treat a sudden illness or injury that isn't a medical emergency.


Denotes preventive services
This symbol identifies the preventive services in the Part B coverage charts above.


Note:
Coinsurance and/or Deductible may apply.

(Primary Source: Centers for Medicare and Medicaid Services - Medicare and You Handbook. This content may have been enhanced by Q1Group LLC to include further examples, explanations, and links.)
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  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.