The National Consumer Protection Technical Resource Center: The Center of Service & Information for SMPs

Health Care Fraud

Medicare Part B (Outpatient Insurance)


Doctor Services

  •  Durable medical equipment
  •  Home health care
  •  X-rays, lab services
  • Outpatient services

Part B Costs

  • Part B premium – Usually taken out of the monthly Social Security, Railroad Retirement, or Civil Service Retirement check sent to a beneficiary.  If a beneficiary does not receive any of these payments each month, a bill will be sent every three months.   Beginning in 2007, for individuals with annual incomes exceeding $80,000, the Medicare Part B premium increases each year will be tied to income.
  • Deductible – Beneficiaries are responsible for the Part B deductible each calendar year.  This amount will be adjusted annually according to increases in Medicare expenditures.
  • Part B Co-insurance – In most cases, Medicare Part B pays 80% of the Medicare approved charges.  After meeting the deductible, the beneficiary is responsible for 20% of the Part B approved charges.
  • Excess Charges – A beneficiary must also pay the excess charges when the physician or supplier does not accept Part B “assignment.” 

Non-covered Services

  • Most routine physical examinations and related tests.  (However, new enrollees are entitled to a “Welcome to Medicare” Physical within six months of initial enrollment in Medicare.)
  • Most routine foot care
  • Examinations for fitting a hearing aid
  • Examinations for eyeglasses unless required by cataract surgery
  • Most routine dental care or false teeth
  • Acupuncture
  • Cosmetic surgery
  • Experimental medical procedures
  • Custodial Care