Medicare Questions & Answers: Medicare Part B
Medicare Part B Q&A
Showing 37 questions
Why do some seniors end up paying lifelong penalties for Medicare Part B or Part D?
Lack of appropriate retirement planning education. One of the foundations I have built my business on is education. Medicare 101 seminars can be really useful to people to learn how to avoid these penalties.It is important to know that unless you have what is known as Creditable Coverage, delaying Part B and or Part D can carry lifelong penalties. Each situation is unique so it’s important to consult with a professional to understand if you have Creditable Coverage or not and have a plan in place, months before you turn 65. Sorting out your Medicare coverage is best done up to 3 months before you turn 65.
Why is regular Medicare better than an advantage plan?
There's a lot of confusion with Medicare-Medicare Supplement/Medigap/-Medicare Advantage "alphabet soup"! Do your homework and learn the Pros and Cons of each Option! Work with someone -like ME-who can offer both: Medicare Supplement/Medigap and Medicare Advantage plans! This was you get the FACTS not the HYPE and then make the best decision for YOU! :) WE can HELP!
I've been diagnosed with prediabetes. What preventive services does Medicare cover to help prevent progression to type 2 diabetes?
Its always a tough when you hear about any diagnosis from a Health Care professional regarding Diabetes. If you watch the news at all, you know that any Diabetes related health condition is serious and effects a large part of our population. Medicare provides several "Preventive Services'" that come at low or no Out of Pockets costs. Medicare Diabetes Prevention Program (MDPP) is a comprehensive One Time health behavior change program is available to help you prevent Type II diabetes. Common services like Diabetes Screening and monitoring, Medical Nutrition, foot exams and Hemoglobin A1C, Glaucoma Screenings as well as "Welcome to Medicare" preventive visits are design to address your diagnosis and prevent it from getting worse! Your Medicare agent can educate you on what is available to you! If you are new to Medicare you will love it!
My friend said she got a free annual physical with Medicare, but my doctor billed me. What's going on?
Annual physicals are always free with Medicare. Perhaps your doctor is not in network? Your agent should always check and ascertain that your primary care physician is in network.
I need a new wheelchair, and I'm not sure if Medicare will cover it. What's the process for getting durable medical equipment?
Original Medicare pays for DME, unless noted anywhere within its policy Medicare Advantage plans do not.You will have the 20% Co-pay responsibility, unless you have a Supplement plan that covers those charges.
That is an important feature in keeping your Original Medicare pays- it handles your DME, Medicare Advantage is typically handled Out-of-pocket by the insured.
I'm still working at 67, and I don't know if I need Part B. Why is something so basic so hard to figure out?
It seems hard but when you know the specifics you can make the right decision for you!If you work for a company with 19 or more employees you can stay on that work plan until you retire and then get Part B! Work with someone like me-who works with Medicare Planning every day for clients! We give great information so folks can make good decisions!
Why am I paying more for Medicare Part B and D than my friends? What is IRMAA and how is it calculated?
When clients ask why their Medicare Part B and D premiums exceed others’, I attribute it to IRMAA, the Income-Related Monthly Adjustment Amount, which increases costs based on higher income reported on their tax return from two years prior. Medicare discourages advisors like me from quoting specific thresholds, instead directing individuals to consult the official income brackets and resources to determine their financial responsibility two years hence. The calculation uses modified adjusted gross income, and significant income events—such as a large asset sale—can elevate the surcharge, often unexpectedly impacting their total premium obligation.
I'm on Original Medicare with no supplement, and I'm wondering how much I'd pay if I need an ambulance ride to the hospital tomorrow.
Without a Medicare Supplement, it falls under Original Medicare, Part B.The key thing is that it be considered medically necessary.
That can even include transport from a hospital to a skilled nursing facility - not just transportation toma hospital.
I'm considering concierge medicine but already have Medicare. How would these work together?
Concierge Care will work with Medicare, but doctors may still charge you for some items that Medicare will not cover but may be covered under Concierge Care. Concierge services are not reimbursed by Medicare.This is good for having an extra layer of coverage. The premium for this coverage is not covered under Medicare, so this is one way to get extra insurance coverage and your Medicare. Medicare Advantage networks also work with Concierge.
Medicare does not reimburse concierge services, which provide this enhanced care.
I'm interested in nutrition counseling to help manage my diabetes. Will Medicare cover this as preventive care?
Medicare part B does cover with a referral from a doctor to a regestiered dietitan or specialist. But it all starts with your doctor.
I want to be proactive about my health. What preventive services should I be taking advantage of with Medicare?
There is a list of preventative services on Medicare.gov. Of course your annual physical, exercise and diet.
I'm a smoker trying to quit. What smoking cessation benefits does Medicare offer for someone in my situation?
Some Medicare Advantage Plans provide Smoking and Tobacco cessation counseling to stop smoking or tobacco use in the Medical Benefits. Some provide counseling visits over a 12 month period at no cost to you.
My doctor prescribed physical therapy, but I'm not sure how many visits Medicare will cover. How do I find out?
The number of physical therapy visits you get depends on what your doctor says. If the therapy is deemed medically necessary, Original Medicare will pay.However, if you have a Medicare Advantage plan and they deny the therapy, appeal the decision. MA coverage is required to be at least as good as Original Medicare so make sure your plan pays for what your doctor says you need.
I'm homebound and need remote monitoring for my heart condition. What Medicare benefits might apply to someone in my situation?
Yes, if your physician deems it medically necessary. However, some other EKG devices are most likely not covered by Medicare.My doctor recommended a bone density test. Is this considered preventive care under Medicare?
Yes, but it is covered under Medicare with a doctor's order. This test is generally covered only once every 24 months.
I just enrolled in Medicare, and I've got my Part A and B, but I'm hearing there are gaps in coverage. What are these gaps exactly?
The Original Medicare ( Part A and Part B) only covers part of your healthcare costs. Beneficiaries must enroll in supplemental insurance plans to cover prescription drug costs, deductibles, co-pays, co-insurance, and the lack of a yearly out-of-pocket limit.The coverage gaps include prescription drug coverage, you can enroll in a stand-alone Part D drug plan.
Other gaps are routine vision, dental, and hearing. Consider enrolling in a Medicare Advantage plan. These plans are an alternative way to get the Original
Medicare, Part A, Part B, and additional benefits.
I thought I signed up for both Part A and B when I got my Social Security, but now I'm getting bills for Part B. Did I miss something during the enrollment period?
Part B has a deductible each year (increases a little each year-2025 is $257) and a 20% co-pay WITHOUT a maximum out of pocket! Have you looked into either a Medicare Supplement/Medigap OR Medicare Advantage Plan that can help with the Part B "out of pocket costs"?
Does Medicare Part A cover outpatient surgery, or is that strictly under Part B?
Medicare Part A does not cover Outpatient surgery. Medicare Part B covers outpatient surgery with 20% coinsurance you are responsible for.
How can I lower my Medicare Part B premium if my income drops after retirement?
Depending on your personal situation you may qualify for a State Medicaid Program…and in certain situations have the State pay for the PART “B” premium.I'm on Medicare Part B, and I'm wondering how my physical therapy visits are covered. Do I have to hit my deductible first?
If your on Medicare A and B only you would 20%. If your on a Medicare Advantage Plan, it usually has a copay that would be deductible for the MOOP.
My income fluctuates significantly year to year from investment distributions. How can I avoid IRMAA surcharges when I have an unusually high-income year?
They use taxes from two years ago (so 2023's taxes for 2025), so you have time to prepare. The brackets change every year and they are tiered so if you just go over a little the penalty is is about $1,200 for the year. Work with your tax advisor if you will be near the current year's levels to reduce you income through things like charitable giving and other tax deductions. Balance the deduction spending against the expected penalty. To be honest, it's a great problem to have. Good work on the savings.I have a family history of colon cancer. Will Medicare cover more frequent colonoscopies for someone in my situation?
Yes, under Medicare A & B, you may find that Medicare will cover your screening potentially every two years, under a doctor's order. Preventive care testing is offered as a separate rider with your Medigap programs, with some insurance carriers. These additional rider programs generally cover one hundred percent of the cost if classified as preventive care screening.My friend got her cataract surgery covered by Medicare, but they didn't cover the lens she wanted. How does that work?
Medicare does cover cataract surgery, and I have personally undergone the procedure. However, they only cover standard lenses, and you will need to pay extra if you want to purchase a premium lens or any other special types. These are considered luxury items or cosmetic options by Medicare and are not deemed absolutely necessary. Nonetheless, Medicare does cover the cost of the surgery as well as the standard lenses.I'm considering a smartwatch that monitors my heart rhythm for atrial fibrillation. Will Medicare help cover this type of wearable technology?
Traditional Medicare with a Medigap plan does not typically cover smartwatches, as Medicare standards have not approved them as medical devices under durable medical equipment (DME) monitoring devices. This is similar to a blood pressure kit that Medicare does not see as a medical necessity under DME monitoring devices. A Medicare Advantage plan may pay for the smartwatch, but it would require prior approval.
I've heard Medicare covers an annual wellness visit. What exactly is included in this visit?
A Medicare Annual Wellness Visit focuses on preventative care and health planning, including a health risk assessment, review of medical history, and creation of a personalized prevention plan, but it's not a full physical
I'm confused about which vaccines Medicare covers. Can you explain which ones are free?
Medicare Part B covers vaccines for the Flu, COVID, Pneumonia, and Hepatitis B. Part B also covers vaccines if you’re exposed to a harmful virus or bacteria by accident, such as a tetanus shot or rabies shotPart D (prescription drug) plans cover vaccines for RSV, Shingles, Tdap (tetanus, diphtheria, and pertussis/whooping cough), and vaccines that are "reasonable and necessary" to prevent illness and are not covered by Part B. Part D may also cover vaccines required to travel internationally.
Are mental health services like therapy fully covered under Original Medicare?
Mental health is covered but it is up to you to review different company policies since they could vary widely from state to state. There is a limited number of days that should be covered. It is incumbent upon you to fully understand those limitations. This is why it is imperative to go over with a knowledgeable agent who can easily differentiate between what an Advantage plan covers vs. what a Med. Suppmt. (Medigap) covers in this extremely important area.
I'm caring for my spouse with dementia and experiencing caregiver burnout. Will Medicare cover any mental health support for me?
Outpatient Mental Health Care (Part B):Covers individual and group psychotherapy with licensed professionals.
Includes annual depression screenings.
Covers psychiatric evaluations and diagnostic tests.
Covers medication management and injections received at a provider's office.
Covers partial hospitalization programs (PHPs).
Covers intensive outpatient programs (IOPs).
Covers other mental health services like substance abuse treatment, occupational therapy, and more.
I've been diagnosed with bipolar disorder at age 66. How should I structure my Medicare coverage to ensure I get the mental health care I need?
Yes. The most obvious means toward doing that is to ask your agent what is covered in your policy in the area of mental health and those medications that are prescribed to treat that malady. If you want to compare your current plan with other companies, it is going to be essential for you to realize that mental health is covered by Medicare but only so much. This depends upon the State you live in, unfortunately. You need to call both Supplement firms as well as those who offer Advantage plans. Based on a "side-by-side" comparison, you should have enough ammunition to make a determination. It would have been better had you come to this conclusion before a full 12-months had elapsed after turning age 65. This means that now you will be subject to underwriting though you won't be declined just for a bipolar disorder but an accumulation of health issues that you might also have.
I keep hearing about free preventive services with Medicare. What exactly is free and what will I still pay for?
Medicare covers preventive services that per the Medicare.gov website are identified as exams, shots, lab tests, and screenings. They key benefit that Medicare does not specifically cover are Routine Physical Exams. The majority of Medicare Advantage plans do cover a routine annual exam and typically they are a $0 copay.It is really important when setting up a routine physical exam with your doctor or provider that you have a good understanding of what services will be provided. For example, lets say your Medicare Advantage plan covers the routine physical exam which would include all of the $0 copay screenings, shots, and lab tests covered by Medicare. Those items would be a $0 copay. I never use the word free and Medicare does not allow a broker to ever use the word free.
It is common though that a good provider will ask you if there are other things you would like to discuss during your visit. Those items could be outside of the routine exam and you might have a copay for that portion of your visit. Lets say for example that you wish to discuss shoulder or knee pain you have been having. Those discussions are generally beyond your preventive $0 copay services and could trigger a copay for you.
In conclusion, its important to know that Medicare encourages all consumers to stay healthy and obtain the preventive services that have a $0 copay. It would only be services beyond or outside of the routine physical exam, tests, labs, screening that you might see additional costs.
How does Medicare Part B handle coverage for preventative screenings like mammograms?
Medicare Part B covers preventive screenings like mammograms as part of its focus on early detection and health maintenance, with specific rules on frequency, cost, and eligibility. Here’s how it works:Screening Mammograms: These are covered for women aged 40 and older to detect breast cancer early, before symptoms appear.
Frequency: Part B fully covers one screening mammogram every 12 months (anytime after 11 months from your last one). If you’re new to Medicare, you also get a baseline mammogram covered between ages 35–39.
Cost: There’s no out-of-pocket cost—no coinsurance, copayment, or Part B deductible—as long as the provider accepts Medicare assignment (agrees to Medicare’s payment rates). This applies to 2D and 3D (tomosynthesis) screenings, though 3D coverage was clarified in updates around 2018 to match evolving standards.
Diagnostic Mammograms: If a screening finds something abnormal or you have symptoms (like a lump), Part B covers diagnostic mammograms to investigate further.
Frequency: No strict limit—covered as medically necessary, which could mean multiple in a year if your doctor orders them.
Cost: After meeting the Part B deductible ($240 in 2025), you pay 20% of the Medicare-approved amount. There’s no cap on how many are covered, but each one triggers that 20% coinsurance unless you have a Medigap plan to offset it.
Key Details: The mammogram must be done at a Medicare-approved facility (like a radiology center or hospital outpatient department). If it’s bundled with other services (e.g., a biopsy), additional costs might apply under Part B’s standard rules. Preventive coverage assumes you’re symptom-free—once it’s diagnostic, it shifts to a treatment framework.
This setup reflects Part B’s broader approach to preventive care: full coverage for annual screenings to catch issues early, with cost-sharing kicking in when it’s about diagnosis or follow-up. It’s a balance between encouraging checkups and managing expenses when care escalates.
I need both a psychiatrist for medication and a therapist for talk therapy. How does Medicare coordinate coverage for these different providers?
Medicare provides coverage for both psychiatric medication management and talk therapy through its Part B (Medical Insurance) and Part D (Prescription Drug Coverage) plans.Psychiatric Medication Management
Medicare Part B covers outpatient mental health services, including visits with psychiatrists or other qualified healthcare providers for psychiatric evaluations and medication management. After meeting the Part B deductible, you typically pay 20% of the Medicare-approved amount for these services if your provider accepts assignment. Provider Acceptance: Not all mental health providers accept Medicare. It's important to confirm with your psychiatrist and therapist that they accept Medicare assignment to ensure coverage. Medicare Advantage Plans: If you're enrolled in a Medicare Advantage Plan (Part C), your plan may offer additional mental health benefits beyond Original Medicare. However, provider networks can be more limited, so verify that your preferred providers are in-network
I'm at high risk for heart disease based on my family history. What additional preventive services might Medicare cover for someone with my risk factors?
If you’re at high risk for heart disease, Medicare DOES cover some extra preventive services that can really help.They’ll cover things like a cardiovascular screening every 5 years, that checks your cholesterol and other key levels. And you also get a yearly visit with your doctor to talk about heart health and how to stay on track with things like diet and exercise.
If your doctor sees any other red flags, there may be more services Medicare can cover, too, but it depends on your situation.
