Part B Medically necessary services

What Are Considered Medically Necessary Services Under Part B?

Medicare is divided into a few components: Part A hospital insurance, Part B medical insurance, Part C Medicare Advantage, and Part D prescription drug coverage. 

Together, Parts A and B form Original Medicare. Through this plan, you can have most health care services covered. This ensures that you only have to pay a portion of the costs for Medicare-approved services. Medicare doesn’t approve everything, but through Part B, most medically necessary services are covered. 

Not sure what medically necessary services are? Here is everything that Part B covers. 

What Does Part B Cover? 

Medicare Part B covers a range of medically necessary and preventive services. According to Healthcare.gov, medically necessary means any health care services or supplies that are needed to diagnose or treat an illness, injury condition, disease or symptoms. In order to be classified as medically necessary, services must meet the currently accepted standards of medicine. Preventive services, on the other hand, are services that are used to prevent the progression of health complications, such as diseases, chronic conditions, and injuries.   

Types of Medically Necessary Services

Some Medicare beneficiaries have found the phrase “medically necessary services” to be a bit vague. To help you, here is a list of medically necessary services that Medicare Part B will cover. 

Clinical Research Studies

Through Part B, Medicare beneficiaries can have the cost of office visits and tests for clinical research studies covered. Clinical research studies, which are also called clinical trials, are studies that test how well different types of medical services work. They are also used to determine whether a treatment is safe for widespread use in the medical community. Through clinical research studies, medical teams compare different treatments for the same condition, study how new treatments or tests benefit their patients, and research new ways to use currently existing treatments. 

Ambulance Services

If you need to be transported to a hospital, Part B also covers ground ambulance transportation when any other form of transportation may compromise your health. Under the correct circumstances, Medicare will also cover airplane or helicopter transportation. This normally only applies when patients have an immediate need for rapid ambulance transportation that would not be possible through ground transportation. 

In some cases, Part B will also cover limited, medically necessary ambulance transportation in non-emergency situations. This requires a written order from a doctor stating that ambulance transportation is necessary. 

It is also important to note that Medicare will only cover ambulance services to the nearest appropriate medical facility that is able to provide you with the care you need. 

Durable Medical Equipment

Some conditions require the use of durable medical equipment. Medicare covers this equipment, as long as it is deemed medically necessary. Some examples of durable medical equipment include:

  • Blood sugar meters
  • Canes
  • CPAP devices
  • Crutches
  • Suction pumps
  • Traction equipment
  • Wheelchairs
  • Hospital beds
  • Oxygen equipment

Mental Health Services

Mental health care is also included in Part B coverage. Through Medicare, you can have a portion of inpatient, outpatient, and partial hospitalization costs covered. There are limits to how often you can use these benefits, but these rules are typically applied under Part A.

Access Your Benefits Today

Don’t wait to get the Part B coverage you need. We can help you get started. Just contact The Medicare Detectives today to schedule a free consultation.