Medicare Part B
The portion of Medicare that covers outpatient medical services, including doctor visits, joint injections, and physical therapy. Requires monthly premium and 20% coinsurance for most services.
Extended Definition
Medicare Part B is federal health insurance that covers outpatient medical services for people 65+ and those with certain disabilities. Most joint pain treatments are covered under Part B.
What Part B Covers for Joint Pain
Covered Services:
- Doctor office visits
- Hyaluronic acid injections
- Corticosteroid injections
- Physical therapy
- X-rays and imaging
- Durable medical equipment (braces, etc.)
- Outpatient surgery
Not Covered:
- PRP injections
- Stem cell therapy
- Most experimental treatments
- Prescription drugs (that’s Part D)
2024 Costs
| Cost Type | Amount |
|---|---|
| Monthly premium | $174.70 (standard) |
| Annual deductible | $240 |
| Coinsurance | 20% of approved amount |
How the 20% Works
After meeting your $240 deductible:
- Medicare approves an amount for the service
- Medicare pays 80% of approved amount
- You pay 20% (coinsurance)
Example: HA injection approved at $400
- Medicare pays: $320
- You pay: $80
Reducing Your Costs
Medigap (Supplement) Plans:
- Plan G or similar covers the 20%
- Monthly premium but predictable costs
- No network restrictions
Medicare Advantage Alternative:
- Replaces Part A and B
- Different cost structure (copays)
- Network restrictions apply
Related Terms
More Insurance Terms
View allAppeal
A formal request to have your insurance company reconsider a denied claim or coverage decision. You have the right to appeal most insurance denials, including Medicare decisions.
Coinsurance
Your share of the costs of a covered service, calculated as a percentage. With Medicare Part B, you pay 20% coinsurance after meeting your deductible.
CPT Code
Current Procedural Terminology codes used by healthcare providers to identify specific medical services for billing. Each joint injection, office visit, or therapy session has a specific CPT code.
Covered Service
A healthcare service that your insurance plan includes in your benefits and will help pay for, assuming you meet all requirements like deductibles and prior authorization.
Deductible
The amount you must pay out-of-pocket for healthcare services before your insurance starts paying. Medicare Part B has an annual deductible of $240 (2024).