5. In general, what benefits are payable under Medical Insurance (Part B)?

Medical Insurance (Part B) is offered to almost all persons age 65 or over on a voluntary basis. In addition, the program is offered to all disabled Social Security and Railroad Retirement beneficiaries who have received disability benefits for at least 24 months. For 2013, there is an annual deductible of $147, paid by the patient. This annual deductible is adjusted to reflect the amount of Medicare Part B costs. Medical Insurance pays 80% of the approved charges above the deductible for the following services:

Physicians' and surgeons' services, whether furnished in a hospital, clinic, office, home, or elsewhere, excluding routine or yearly physical exams.
A one-time initial wellness physical within 6 months of enrolling in Medical Insurance (Part B).
Screening blood tests for early detection of cardiovascular disease.
Diabetes screening tests for those at risk of getting diabetes.
Home health care visits, if not covered under Hospital Insurance (Part A) (but with no cost-sharing except for durable medical equipment, other than the purchase of certain used items). In the past, few home health care visits were covered under Medical Insurance (Part B) but this has changed because of the creation of separate Hospital Insurance and Medical Insurance home health benefits in 1998.
Outpatient hospital services for the diagnosis or treatment of an illness or injury.

Diagnostic x-ray tests (including certain portable X-ray services in the home), diagnostic laboratory tests, and other diagnostic tests (no cost-sharing).
Outpatient physical therapy and outpatient speech-language pathology services furnished by participating hospitals, skilled nursing facilities, home health agencies, outpatient therapy clinics, or by others under arrangements with, and under the supervision of, such organizations.
Outpatient physical therapy services and outpatient speech-language pathology services provided in a hospital or skilled nursing facility to its inpatients who have exhausted their inpatient days, or are otherwise not entitled to Hospital Insurance benefits.
Outpatient physical therapy services and occupational therapy services furnished by a licensed, independently practicing physical therapist or occupational therapist in his or her office or the patient's home, provided the patient is under the care of a physician.
Rural health clinic services and federally qualified health center services.
Prosthetic devices (other than dental) which replace all or part of a covered body part, including replacement of such devices.
Home dialysis supplies and equipment, self-care home dialysis support services, and institutional dialysis and supplies.
Chiropractor's treatment by manual manipulation of the spine to correct a subluxation of the spine. But the cost of the chiropractor's X-ray, if any, is excluded.
Podiatrist's services (excluding the treatment of flat foot conditions, subluxations of the foot, and routine foot care that does not require treatment by a podiatrist or physician).
Leg, arm, back, and neck braces, and artificial legs, arms, and eyes, including replacements where necessary because of a change in the patient's condition.
Rental or purchase of durable medical equipment.
X-ray, radium, and radioactive isotope therapy, including materials and services of technicians.
Surgical dressings, and splints, casts, and other devices for reduction of fractures and dislocations.
Ambulance services, under certain circumstances.
Blood clotting factors for hemophilia patients and items related to its administration.
Hospital services incident to a physician's services to an outpatient (including drugs and biologicals which cannot be self-administered).
Antigens prepared by a physician for a particular patient.
Annual flu shot (no cost-sharing).
Pneumococcal vaccine and its administration (no cost-sharing).
Hepatitis B vaccine and its administration (if beneficiary considered at high or intermediate risk of contracting disease).
Certified nurse-midwife services.
Partial hospitalization services provided by a community mental health center or hospital outpatient department.
Screening pap smear and pelvic exams.
Prostate cancer screening tests.
Annual screening mammography for all women age 40 and over (the Part B deductible is waived).
Colorectal cancer screening.
Diabetes monitoring and self-management benefits.
Bone mass measurements.
The cost of an injectable drug for the treatment of a bone fracture related to post-menopausal osteoporosis.
Eyeglasses following cataract surgery.
Services of nurse practitioners and clinical nurse specialists in rural areas for the services they are authorized to perform under state law and regulations.
Oral cancer drugs if they are the same chemical entity as those administered intravenously and currently covered. Off-label cancer drugs are covered in some cases.
Necessary medical supplies.
Immunosuppressive drug therapy.
Lung and heart-lung, liver and kidney transplants under certain circumstances.

The cost of psychiatric treatment outside a hospital for mental, psychoneurotic, and personality disorders is covered. But coinsurance is usually 50% instead of 20%.

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