Medicare Part B covers medically necessary doctor and other health care provider’s services, outpatient services (including physical and speech therapy), laboratory tests, certain medical equipment and supplies, some home health care (does not cover custodial-only care), and certain ambulance services. Part B also covers certain preventive services to prevent illness or detect it at an early stage. Most Part B benefits are subject to an annual deductible and also a coinsurance of 20%. The Annual Wellness Visit and some preventive services are not subject to the deductible and/or coinsurance.
An agreement by the doctor, provider, or supplier to be paid directly by Medicare, to accept the payment amount Medicare approves for the service, and not to bill for any more than the Medicare deductible and coinsurance (as applicable).
If the amount a doctor or other health care provider is legally permitted to charge is higher than the Medicare-approved amount, the difference is called the excess charge.
The highest amount of money a beneficiary can be charged for a covered service by doctors and other health care suppliers who don't accept assignment. The limiting charge is 15% over Medicare's approved amount. The limiting charge only applies to certain services and does not apply to supplies or equipment.
Physicians’ Services
Physicians' services are those professional services performed by a physician for a patient including diagnosis, therapy, surgery, and consultation. The term “physician” includes a Doctor of Medicine or Osteopathy legally authorized to practice by a State.
Medical Services
Covered medical services include a number of different medical services and supplies which may be necessary for the treatment and diagnosis of an illness or injury. They may be furnished as part of a doctor's treatment, or by a provider, an independent laboratory, the outpatient department of a hospital, a medical clinic, or an ambulatory surgical center. They include services and supplies (e.g., drugs and biologicals which cannot be self-administered) furnished as an incident to a physician's professional service.
Durable Medical Equipment (DME) (requires a prescription by a doctor)
DME covered by Medicare includes (but is not limited to) blood sugar meters, CPAP devices, hospital beds, infusion pumps, oxygen equipment, walkers, and wheelchairs. Medicare pays for different kinds of DME in different ways. Depending on the type of equipment, a beneficiary may need to rent the equipment, buy the equipment, or may be able to choose whether to rent or buy the equipment.
Medicare will only cover DME if doctors and DME suppliers accept Medicare assignment. Doctors and suppliers have to meet strict standards to enroll and stay enrolled in Medicare. If doctors or suppliers don't accept Medicare assignment, Medicare won’t pay the claims submitted by them. It’s also important for beneficiaries to ask suppliers if they participate in Medicare before they get DME. If suppliers are enrolled in Medicare but aren’t “participating,” they may choose not to accept assignment. If suppliers don't accept assignment, there’s no limit on the amount they can charge a beneficiary.
Medicare costs at a glance.
Learn more about Medicare coverage for durable medical equipment coverage in your home.
