Medicare Questions & Answers: Medicare Part B

Medicare Part B Q&A

Showing 37 questions

Answered by Samantha Jellison Medicare Insurance Agent

Samantha Jellison

Securely Insured LLC • Green Mountain, NC

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.
Answered by Larry Dalton Medicare Insurance Agent

Larry Dalton

D&D Ins. Group, LLC • Durant, OK

My friend said she got a free annual physical with Medicare, but my doctor billed me. What's going on?

Medicare does not provide annual physicals; these are called wellness exams. If the doctor bills it as a physical, you will most likely pay 100%. However, if you have a Medicare Advantage plan, it may be covered as an annual physical under your policy coverage. All Medicare Advantage plans are different, and their coverage for these items varies; check your policy.

Under traditional Medicare Part A and B, you can receive a yearly wellness exam. Talk to your doctor about the upcoming exam and what it entails.
Answered by Mark Cunningham Medicare Insurance Agent

Mark Cunningham

Loveland Insurance Agency • Loveland, CO

Why is regular Medicare better than an advantage plan?

Making the choice between regular Medicare with Medigap/Medicare Supplement or a Medicare Advantage Plan depends on individual healthcare needs, preferences, and financial situations. Regular Medicare with Medigap/Medicare Supplement provides notable advantages in terms of flexibility, coverage, predictability, and support. Choosing to prioritize these factors you may find regular Medicare with Medigap/Medicare Supplement to be a superior option. Understanding the differences and benefits of each choice is essential for making an informed decision about healthcare coverage.
Answered by Sherah Beasley Medicare Insurance Agent

Sherah Beasley

Local Heritage Benefits • The Woodlands, TX

Why am I paying more for Medicare Part B and D than my friends? What is IRMAA and how is it calculated?

If you’re paying more for Medicare Part B (medical insurance) and Part D (prescription drug coverage) than other people you know, it’s likely due to something called IRMAA – the Income-Related Monthly Adjustment Amount.

IRMAA is an additional amount that people with higher incomes must pay on top of their standard Medicare premiums. It affects Medicare Part B and Part D. The Social Security Administration (SSA) determines if you owe IRMAA based on your reported income.

Your friends might have a lower reported MAGI, different filing statuses, or different income sources. Even similar incomes can result in different IRMAA outcomes depending on deductions, tax-exempt interest, or capital gains.
Answered by Jay Carlton Medicare Insurance Agent

Jay Carlton

Insurance Guy JC • Magna, UT

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.

You will have a charge of the Part B deductible first which as of 2025 will be $257 and then 20% of the charge of the ambulance company charge in your area (state/city) you live.
Answered by Tony Capraro III Medicare Insurance Agent

Tony Capraro III

State Farm • Manchester, NH

What's the financial risk of sticking with Original Medicare without a Medigap plan?

Answered by Morris Johnson Medicare Insurance Agent

Morris Johnson

Licensed Agent • Augusta, KS

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.
Answered by Steven Bleicher Medicare Insurance Agent

Steven Bleicher

Independent Representative • Oro Valley, AZ

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?

Yup. If you don't speak to an experienced and honest agent, you won't know what your monthly payments will be. For example, there is a premium for the Part B, for the Part B one-time per year deductible, possibly a Medigap plan along with a Part D(rug) plan. If you want better coverage for the more expensive Dental, Vision & Hearing procedures, that can also be an extra cost per month. Sounds like you tried to get around using an agent whereas YOU are not paying for the agent's commission since the firm you chose pay the agents!
Answered by Clare Burley Medicare Insurance Agent

Clare Burley

Bridlewood Insurance • Castle Rock, CO

My doctor recommended a bone density test. Is this considered preventive care under Medicare?

Yes, bone density screenings are considered preventive under Medicare Part B. They are typically covered every 24 months, however they can be approved more frequently if medically necessary.
Answered by John Stagner Medicare Insurance Agent

John Stagner

Stagner Insurance Agency LLC • Salem, MO

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?

Answering the first question first: it’s hard to figure out because the government wrote it! They don’t really understand how to make things simple.…

Here’s the quick rule about employer insurance after age 65: if your employer has 20 or more employees and you are covered by the employer’s insurance and still working, you can delay part B as long as you want with no concern about having a penalty later. The moment that you stop working for that employer or discontinue that insurance, that’s the time that you need to enroll into Medicare part B in order to avoid a penalty.

I always advise my clients to compare the costs and coverage of the employer plan versus Medicare so they can make an informed decision.
Answered by Steven Bleicher Medicare Insurance Agent

Steven Bleicher

Independent Representative • Oro Valley, AZ

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.
Answered by John L Herman Jr Medicare Insurance Agent

John L Herman Jr

Health Solutions Team • Lutherville, MD

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.
Answered by Diane Andree Medicare Insurance Agent

Diane Andree

ABC Medicare Plans Broker • Mastic, NY

My income fluctuates significantly year to year from investment distributions. How can I avoid IRMAA surcharges when I have an unusually high-income year?

IRMAA charges are calculated each year based on your tax return of two years ago. In any one year, you have a fluctuation, you can appeal an IRMAA by filling out an SSA-44 form. this can be found on and downloaded from the SSA.gov website.
Answered by Yasmery Vargas Medicare Insurance Agent

Yasmery Vargas

MediConnect • Reading, PA

I've been diagnosed with prediabetes. What preventive services does Medicare cover to help prevent progression to type 2 diabetes?

Preventive care is not done on the bases of your medicare but on the quality of care from your doctor. A good doctor will provide good care and education to prevent progression of illness. Depending on your insurance and dietary needs set by your physiscian, you can utilize benefits like nutrition health as well as gym memberships to support a good healthy habit which are typically included with your coverage.
Answered by Cynthia Nakaya Medicare Insurance Agent

Cynthia Nakaya

Licensed Agent • Jurupa Valley, CA

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.
Answered by Norman Smith Medicare Insurance Agent

Norman Smith

Bankers Life • South Bradenton, FL

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.
Answered by Larry Dalton Medicare Insurance Agent

Larry Dalton

D&D Ins. Group, LLC • Durant, OK

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.
Answered by Charles Fletcher Medicare Insurance Agent

Charles Fletcher

The Fletcher Agency • Spokane, WA

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.
Answered by Diana Garner Medicare Insurance Agent

Diana Garner

American Senior Benefits • Hartford, KY

I'm a smoker trying to quit. What smoking cessation benefits does Medicare offer for someone in my situation?

Medicare provides some support to help beneficiaries who are trying to quit.

Medicare Part B covers a variety of preventive services, and smoking cessation counseling is included.

Medicare Part D (prescription drug) plans may cover prescription medications or nicotine inhalers and nasal sprays that require a prescription.
Answered by Clarence "Mark" Christiansen Medicare Insurance Agent

Clarence "Mark" Christiansen

Christiansen Insurance Services • Mequon, WI

My doctor wants me to try acupuncture for my back pain. Will Medicare cover any of this?

Answered by Diana Garner Medicare Insurance Agent

Diana Garner

American Senior Benefits • Hartford, KY

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 shot

Part 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.
Answered by Comfort Olude Medicare Insurance Agent

Comfort Olude

Comfort Olude Health and Life Financial Services, LLC • Lancaster, CA

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.
Answered by Gary Henderson Medicare Insurance Agent

Gary Henderson

Medicare Genius • Seabrook, TX

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.
Answered by Christopher Garcia Medicare Insurance Agent

Christopher Garcia

Licensed Broker • Las Cruces, NM

I want to be proactive about my health. What preventive services should I be taking advantage of with Medicare?

medicare has a standardized list of preventive services that are covered as well as as a standard frequency when you should be getting these screenings. Your summary of benefits should have a list of these in your preventive services section. Sometimes the frequency can vary based on medical history and necessity. It’s important to work with your doctor to determine if your screening should be done more frequently than the standard.
Answered by Robert Helmkamp II Medicare Insurance Agent

Robert Helmkamp II

Helmkamp Insurance Solutions • Cottonwood, AZ

I'm considering a smartwatch that monitors my heart rhythm for atrial fibrillation. Will Medicare help cover this type of wearable technology?

No, Original Medicare Parts ( A and B) do not cover Fitness Smartwatches that track heart rhythm or other vitals. Also Original Medicare does not cover Medical Alert Devices. If you are interested in getting either and having it covered by Insurance, some Medicare Advantage Plans offer coverage for these devices.
Answered by Steve Houchens Medicare Insurance Agent

Steve Houchens

Steve Houchens Insurance • Glasgow, KY

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
Answered by Wayne Rigby Medicare Insurance Agent

Wayne Rigby

Utah • American Fork, UT

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?

I am assuming you are on Original Medicare Part B and not an Advantage plan.

Yes, you have to meet your Part B deductible then you would have copayments for those services. The deductible this year is $257.
Answered by Scott Sims Medicare Insurance Agent

Scott Sims

Scott Sims Medicare • Eugene, OR

I'm considering concierge medicine but already have Medicare. How would these work together?

I have met with a local concierge Dr and she requested that if working with Medicare advantage, PPO plans would be a good fit since they are not in-network with the Medicare advantage plans. As of recently, one of the local health plans told me their HMO plan does work with concierge. So it sounds like they are more flexible now, don't need a PPO is what I've been told!
Answered by Dana Dane Medicare Insurance Agent

Dana Dane

Dana Dane Insurance • Florence, OR

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?

Medicare Supplements and Medicare Advantage plans cover mental health visits and hospitalization due to mental health. Part D prescription drug plans cover medications. Please contact your agent to see if your medications are covered. If you do not have Medicare yet, please contact a local agent to help you.
Answered by Edward Givens Medicare Insurance Agent

Edward Givens

HealthMarkets • Tempe, AZ

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
Answered by Timothy Brown Medicare Insurance Agent

Timothy Brown

MediConnect • Harrisburg, PA

I have a family history of colon cancer. Will Medicare cover more frequent colonoscopies for someone in my situation?

If someone is deemed to be at high risk for colon cancer, Medicare will cover frequent colonoscopies every 2 years. Your doctor or other health care provider may recommend you get services more often than Medicare covers. An additional plan such as a Medicare Supplement or a Medicare Advantage can provide such additional coverage.
Answered by Kathy Adams Medicare Insurance Agent

Kathy Adams

Bridlewood • North Las Vegas, NV

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?

Based on family history of heart disease, you may consider a Medicare Supplemental Plan, to go along with your original Medicare, this would give you the best coverage if you encountered major issues so your medical expenses would have the best coverage available to you.
Answered by Larry Dalton Medicare Insurance Agent

Larry Dalton

D&D Ins. Group, LLC • Durant, OK

I'm confused about preventive services under Medicare. Which screenings are actually free?

When it comes to Medicare, with Medicare Part A and B and the additional purchase of a Medicare supplement, or some call it Medigap, you can receive several preventive screenings and services at no cost. Diabetes, colon cancer, depression, hepatitis B, hepatitis C, HIV, cholesterol, and mammograms can all be covered without cost, if you have a Medicare supplement plan added to your traditional Medicare Part A and B.
Answered by Steven Bleicher Medicare Insurance Agent

Steven Bleicher

Independent Representative • Oro Valley, AZ

I'm homebound and need remote monitoring for my heart condition. What Medicare benefits might apply to someone in my situation?

There can be a wide variety of answers to this question due to the various symptoms that folks can have. There are tools that can be used to "remotely" signal to an outside location that your heart is working properly (or not). You will be beholden to your cardiologist who is your expert and will write up "A PLAN OF CARE" specifically for you. It might entail a number of hours a day where the doctor feels that a registered nurse ought to see you daily or every other day, depending upon the cardiologist's discretion. The other side of this coin is that I can only presume that an operation to remedy your dilemma is out of the question. It can sometimes have a lot to do with which plan you picked up at age 65 between a Medigap or Supplement vs. a Med. Advantage plan both of which demonstrate differing benefits.
Answered by Larry Dalton Medicare Insurance Agent

Larry Dalton

D&D Ins. Group, LLC • Durant, OK

I've heard about new AI-powered diagnostic tools for early disease detection. Does Medicare cover any of these cutting-edge technologies?

Yes, Medicare is increasingly covering AI diagnostic tools and services. AI is becoming a major player in all aspects of our lives and continues to grow in knowledge every day. It is being used to help diagnose people’s healthcare problems. However, it’s in its early stage and still needs to have the oversight of humans' approval before it can be accepted as a proper diagnosis.
Answered by Steve Wilson Medicare Insurance Agent

Steve Wilson

Integrated Insurance, Inc. • Farmington, MN

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.
Answered by Don Hudson Medicare Insurance Agent

Don Hudson

Amazing Health & Life Insurance • Sebastian, FL

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.

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