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Health Care Reform:

Health Insurance & Affordable Care Act

Medicare Part B: Doctor Costs and Lab Tests

Medicare Part B pays for outpatient medical care, such as doctor visits, some home health services, some laboratory tests, some medications, and some medical equipment. (Hospital and nursing home stays are covered under Medicare Part A, as are some home health services.)

If you qualify to get Medicare Part A, you're also qualified for Medicare Part B. If you're age 65 and receive Social Security checks, you're automatically enrolled. However, you may opt out.

If you are age 65 or older but don't get Social Security payments, you can still apply. Call Social Security at 800-772-1213, visit the web site at www.socialsecurity.gov, or apply at your local Social Security office.

For Part B, you have to pay a monthly fee (called a premium) which is usually taken out of your Social Security payment.For 2015, this fee is $104.90 per month. 

But if you have a higher than average personal income (over $85,000) or household income (over $170,000), you will have to pay a higher monthly premium for Medicare Part B. The monthly adjustment will vary from $42.00 to $230.80 more, with a maximum premium of $335.70 in 2015. 

There’s also a yearly deductible of $147 in 2015. After you pay $147 yourself, your benefits kick in. After that, Medicare will pay 80% of the cost of most Part B services, and you (or your Medigap policy) pay the other 20%.

Finally, it’s important to know that there's a penalty for signing up late for Part B. If you don't sign up for Medicare Part B when you first become eligible (and you don’t have comparable coverage from an employer), your monthly fee may be higher than $104.90. You’ll pay a lifetime 10% penalty for every 12 months you delay your enrollment.

  • Medical and other services. Medicare Part B pays 80% of most doctor's services, outpatient treatments, and durable medical equipment (like oxygen or wheelchairs). You pay the other 20%. Medicare also pays for mental health care costs.
  • Laboratory and radiology services. This includes blood tests, X-rays, and other tests.
  • Outpatient hospital services. Medicare Part B covers some of these fees. You must pay a co-payment for outpatient hospital services The exact amount varies depending on the service.
  • Home health care. Medicare Part B pays for nurses and some therapists to provide occasional or part-time services in your home. As long as the provider is certified by Medicare, you pay nothing -- except for 20% of the charges for some medical equipment, such as wheelchairs and walkers.
  • Preventive services. Medicare Part B helps pay for a number of tests, screenings, vaccinations, and a one-time physical exam to help you stay healthy. Many of these services are available at no cost at the time of the visit. Part B also covers screening and counseling for alcohol use (for people who are not considered alcoholic), obesity screening and counseling, screening for depression, sexually transmitted infections screening and counseling, and cardiovascular behavioral counseling.
  • Blood for transfusions. After the first three pints within a calendar year, Medicare pays 80% of the costs for blood you need as an outpatient.
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