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Medicare Part B
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Important Points
Medicare Part B covers a wide array of medically necessary outpatient services.
Medicare Part B covers 80% of Medicare-approved services, leaving you responsible for 20%.
Most people pay the standard monthly premium for Part B, but you may pay more if your income level is above a certain amount.
Many people think of Medicare Part B as their medical coverage, but it actually covers things both in and outside of the hospital. It's best to think of Medicare Part B coverage as any care administered by a physician.
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What does Medicare Part B cover?
Medicare Part B covers most of your healthcare services and provides you access to an array of outpatient medical services. It covers a lot of ordinary outpatient things such as lab testing, doctor's visits, ambulance rides, home health care, and some chiropractic care. It also covers preventive care that includes vaccines, mammograms, colonoscopies, and more.
Sometimes Part B also covers things that occur in the hospital. These include things like surgeries, radiation or chemotherapy for cancer, diagnostic imaging, medical equipment, physician's services, and dialysis for failing kidneys. Additionally, Part B also pays for drugs that are administered in a clinical setting, such as injections, infused drugs, antigens, and insulin that is used with an insulin pump.
All other drugs fall under Medicare Part D.
Medicare Part B is optional, but if Medicare is going to be your only coverage, you definitely need it. Additionally, you cannot get a Medigap or Medicare Advantage plan without being enrolled in Medicare Part B.
What does Medicare Part B pay for?
Your Medicare Part B pays for 80% of approved medical costs after you first pay your annual deductible.
How much does Medicare Part B cost?
Medicare Part B does have a monthly premium. Most people will pay the standard monthly amount set by the government each year. In 2025, the base rate for Part B is $174.70 per month, but you may owe more if your income is above a certain level.
You can find a chart showing your cost based on your income bracket on our IRMAA page. If you enroll late for Medicare Part B, you may also have to pay a penalty for life. It's so important not to miss your enrollment deadline window when you retire and lose access to your employer group health insurance.
Medicare can deduct your Part B monthly premium from your Social Security check if you are already drawing benefits. If not, they will bill you quarterly. There will be a credit card option at the bottom of your quarterly invoice. Just complete the bottom portion of the payment coupon and mail it to the Medicare Premium Collection Center.
You can also use Medicare Easy Pay, which is a free auto-draft service that will deduct your premium payments each month from a checking or savings account.
How do I enroll in Medicare Part B?
If you are already drawing Social Security income benefits at age 65 you do not need to enroll. The Social Security Administration will automatically enroll you and your card will arrive in the mail 1-2 months prior to your 65th birthday.
If you are not drawing Social Security benefits you will need to apply for Medicare Part B. You can do so a few different ways:
Online (at Social Security) - It's the easiest and fastest way to sign up and get any financial help you may need. (You'll need to create your secure my Social Security account to sign up for Medicare or apply for benefits)
Call Social Security at 1-800-772-1213. TTY users can call 1-800-325-0778.
If you or your spouse worked for a railroad, call the Railroad Retirement Board at 1-877-772-5772
It's easy to sign up for Medicare Part B, but it's important that you do so during your Initial Enrollment Period unless you have other creditable coverage through your employer or your spouse's employer. If you do not enroll in Part B in time you would be subject to a penalty!
Does Medicare Part B cover all outpatient care?
Medicare Part B usually covers anything that is deemed to be medically necessary. If a doctor documents your need for a certain procedure, it will usually be covered. In the rare instance that Medicare disagrees with the doctor on the medical necessity of the procedure, some additional documentation might be required.
What doesn't Medicare Part B cover?
Part B doesn't cover any hospital expenses that are already covered by Part A. Additionally, it does not cover dental, vision, hearing, foot care, or cosmetic procedures. It also will not cover drugs that you pick up yourself at a retail pharmacy. You will need a Part D drug plan for those.
In a nutshell, Medicare Part B doesn't cover anything that is not reasonable and necessary. Your doctor will usually know the rules for what is and isn't covered.
What is my cost-sharing?
You will pay a percentage of the costs for your Part B services. Currently, these costs are:
The annual Part B deductible ($240 in 2025)
20% of the remaining costs - with no limits or caps
Any excess charges that a provider or facility may charge beyond what Medicare reimburses
The aspect of Part B that leaves you the most financially exposed is the 20% that you will owe for outpatient medical care. If you have to have surgery or chemotherapy, your expenses can add up to the tens of thousands of dollars. There is no reason you need to be subject to these expenses. Much of these expenses can be covered by a Medigap (Medicare Supplement) plan or a Medicare Advantage plan. There are options available for any budget.
What is the Medicare Part B Late Enrollment Penalty?
If you fail to sign up for Medicare Part B when you are first eligible and you didn't have any creditable coverage, either through your employer or your spouse's employer, you will be subject to the Medicare Part B late enrollment penalty. The penalty is equal to 10% of the base Part B premium per year for every year (12 full months) that you waited to enroll. This penalty gets added to your standard Part B premium and never goes away.
For example, if you didn't have any creditable coverage through an employer plan and you waited until you were 67 to enroll in Part B, here is what the penalty would look like:
20% (10% for each year you missed) of the standard premium of $174.70 = $34.94. This will be permanently added to your monthly premium.
So your monthly payment would be $209.64 per month. ($174.70 standard monthly premium + $34.94 penalty)
Additionally, when you finally do decide to enroll, you will need to wait for the Medicare General Enrollment Period to sign up for Part B. This period runs from January 1st to March 31st each year. Your benefits would then begin on the 1st of the following month after you apply. This can be especially tricky because not only do you now owe the penalty, but you have to wait several months for your coverage to kick in. It is always best to apply when you are first eligible.
If you enrolled later because you've had employer group health coverage, you will not be subject to the Part B late enrollment penalty. When you leave that employer group coverage you will have 8 months to sign up for Part B. This is your Special Enrollment Period for Part B.
Getting help with Medicare Part B
There are two main options that will help protect you against catastrophic medical spending:
1) Medicare Supplement Plans (Medigap Insurance) is available for purchase to cover the things that A & B don't.
2) Medicare Advantage plans are a less expensive option if you are open to getting your A & B benefits through a private health insurance plan with a small service area (generally a handful of counties around your address). Additionally, there are many Medicare Advantage plans that help cover the gaps from Part B that cost $0 per month.
You can read more about purchasing a Medicare Supplement Plan or enrolling in a Medicare Advantage plan or contact us for a FREE consultation at (866) 440-1885 today. Our Medicare experts can help you compare your options, explain your Part B coverage, and find the most suitable plan for you.
Key Points
Signing up for Medicare Part B at the right time is important to avoid late enrollment penalties.
Part B covers outpatient services, certain medications, preventative care, and some hospital services.
You can enroll in a Medigap or Advantage plan to help cover your portion of the cost-sharing with Medicare Part B.
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