Key Takeaways

• Medicare Part B covers essential outpatient services but has gaps that may leave you with unexpected costs.

• Understanding these gaps can help you plan for additional coverage and avoid financial surprises.

Medicare Part B: What It Covers and What It Doesn’t

Medicare Part B is a crucial part of Original Medicare, covering outpatient services, preventive care, and medically necessary services. However, it does not cover everything, leaving many beneficiaries concerned about potential gaps. Knowing these gaps in advance can help you make informed decisions about supplemental coverage options.

Common Concerns About Medicare Part B

1. Monthly Premiums and Out-of-Pocket Costs

One of the first concerns people raise about Medicare Part B is the monthly premium. This amount is typically deducted from your Social Security benefits, but it can increase based on your income. Additionally, there are out-of-pocket expenses, such as:

• Annual Deductible – You must pay this amount before Medicare starts covering services.

• Coinsurance – Medicare Part B generally covers 80% of approved medical costs, leaving you responsible for the remaining 20%.

• Excess Charges – Some doctors charge more than the Medicare-approved amount, and you may be responsible for the difference.

2. No Coverage for Routine Dental, Vision, and Hearing Services

A major gap in Medicare Part B is that it does not cover routine dental, vision, or hearing care. This means you’ll have to pay out-of-pocket for services like:

• Dental cleanings, fillings, and dentures

• Eye exams for glasses or contact lenses

• Hearing aids and exams for fitting them

Many beneficiaries seek additional coverage, such as stand-alone plans or Medicare Advantage plans, to fill these gaps.

3. Prescription Drug Coverage Isn’t Included

Another big concern is that Medicare Part B does not cover most prescription drugs. While it covers some medications administered in a clinical setting (such as chemotherapy or injections), it does not include outpatient prescriptions. To get coverage, you must enroll in a separate Medicare Part D plan or another form of prescription drug coverage.

4. Skilled Nursing and Long-Term Care Limitations

Medicare Part B does not cover long-term custodial care in nursing homes or assisted living facilities. While it may cover short-term skilled nursing care under certain conditions, long-term care services like bathing, dressing, and basic daily activities are not covered. This can lead to high out-of-pocket costs for those needing extended care.

5. Ambulance Services and Emergency Care Costs

Medicare Part B does cover ambulance transportation, but only when deemed medically necessary. If Medicare determines that an ambulance was not essential for your condition, you may be responsible for the full cost. Additionally, emergency care services are subject to the standard 20% coinsurance, which can add up quickly in the event of a serious illness or accident.

6. Limited Coverage for International Travel

If you travel outside the U.S., Medicare Part B generally does not cover healthcare services received abroad. There are very few exceptions, meaning you could be fully responsible for any medical expenses incurred while traveling internationally. Many retirees who travel frequently look into supplemental plans that offer some level of international coverage.

7. The Need for Supplemental Coverage

Because of these gaps, many Medicare beneficiaries choose to enroll in supplemental insurance, such as:

• Medigap (Medicare Supplement) Plans – Help cover out-of-pocket costs like deductibles, coinsurance, and excess charges.

• Medicare Advantage (Part C) Plans – Often include dental, vision, hearing, and prescription drug coverage, but come with provider network restrictions.

Understanding your options for supplemental coverage can prevent unexpected medical bills and help you budget for your healthcare needs.

Preparing for Medicare Part B’s Limitations

To ensure you’re financially protected, consider the following steps:

1. Evaluate your healthcare needs – Consider how often you see doctors, what medications you take, and whether you need additional services like dental or vision care.

2. Explore Medigap or Medicare Advantage plans – These plans can help fill coverage gaps and reduce out-of-pocket expenses.

3. Look into additional coverage for prescriptions – A Medicare Part D plan can help cover prescription drug costs.

4. Plan for long-term care needs – Since Medicare does not cover custodial care, think about long-term care insurance or other financial strategies.

5. Check travel coverage – If you travel frequently, look into travel insurance or supplemental plans with international coverage.

Don’t Let Medicare Part B’s Gaps Catch You Off Guard

Medicare Part B provides essential coverage, but it’s important to recognize its limitations. By understanding these gaps, planning for supplemental coverage, and budgeting for potential costs, you can ensure that your healthcare needs are met without financial strain. Be proactive in reviewing your coverage options so that you can make the most of your Medicare benefits.