Medicare Part B is considered your outpatient coverage. With Part B, all items, tests, services, and procedures covered must fall under one of two categories. The two categories of coverage for Medicare Part B are preventive services and medically necessary services.
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Medicare Part B Medically Necessary Services
The second category of services covered under Medicare Part B are known as medically necessary services. These are services required to either diagnose or treat a medical condition. These services can apply to both new and pre-existing conditions under Original Medicare.
Cost of Medicare Part B Medically Services
Unlike preventive services, there is a cost-share for Medicare enrollees for medically necessary services. The first cost-share comes in the form of the Part B annual deductible. Under Original Medicare, this annual deductible must be met before Medicare Part B pays any portion of these services. In 2021, the Part B annual deductible is $203.
Once the Part B deductible has been met, most medically necessary services are covered at an 80/20 split. This means that Medicare Part B will pay its share of 80% for these services, leaving you responsible for 20%. You will continue paying 20% until the end of the calendar year. If you doctor or provider does not accept Medicare Assignment, you may also pay an excess charge for any services, which can be up to 15% of the Medicare-approved amount.
What is Considered a Medically Necessary Service?
As mentioned before, these are services designed to diagnose and treat illnesses. Medicare’s website has an item, test, or service search that helps determine which services fall under the medically necessary service category.
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Medicare Part B is considered your outpatient coverage. With Part B, all items, tests, services, and procedures covered must fall under one of two categories. The two categories of coverage for Medicare Part B are preventive services and medically necessary services.
