Medicare Part B
Medical insurance covering outpatient services, physician visits, preventive care, durable medical equipment, and some home health services; requires a monthly premium paid by the beneficiary.
Medicare Part B covers outpatient medical services — physician office visits, specialist consultations, outpatient surgery, lab tests, X-rays, diagnostic imaging, durable medical equipment (wheelchairs, CPAP machines), mental health services, and preventive screenings. The standard 2024 monthly premium is $174.70, but high-income beneficiaries pay more under IRMAA surcharges that can push the premium to $594/month at the highest income tier.
Part B has a $240 annual deductible (2024). After the deductible, Medicare pays 80% of the Medicare-approved amount for covered services; the beneficiary pays the remaining 20% with no out-of-pocket cap. This 20% coinsurance is the primary reason most beneficiaries purchase a Medigap supplement plan — a single major illness can generate tens of thousands of dollars in 20% coinsurance.
Part B covers home health care when a patient is homebound and requires intermittent skilled nursing or therapy. It does not cover custodial care (bathing, dressing, meal preparation) when that is the only service needed. Ambulance services, mental health inpatient (with a 190-lifetime-day limit in a psychiatric hospital), and clinical research participation are also covered under Part B.
Real-World Example
After knee replacement surgery, a 68-year-old patient received 12 outpatient physical therapy visits at $180/session (Medicare-approved amount). Medicare paid 80% ($172.80/visit) after the $240 deductible; the patient's 20% share totaled $288 plus the deductible — $528 for the full PT course.