Medicare Part B(Medical Insurance)
Medicare Part B is one of the four main parts of Medicare. It works alongside Part A (also called Hospital Insurance) to provide beneficiaries with healthcare coverage.
While Part A primarily covers inpatient services, Part B focuses on outpatient and preventive care, as well as tests and screenings (amongst other things). When put together, Parts A and B make up what is typically referred to as 'Original Medicare.'
What is Medicare Part B?
Medicare Part B (also known as Medical Insurance) is the component of Medicare that covers outpatient care, including doctors' services, preventive care, clinical research, ambulance services, mental health and substance abuse services, diagnostic tests and screenings, and Durable Medical Equipment (DME). There are four main parts of Medicare (Parts A, B, C, and D).
What does Medicare Part B cover?
As stated above, Medicare Part B covers outpatient medical services that have been deemed medically necessary. This includes:
Doctor Visits: Standard doctor's office visits with primary care providers and specialists, when deemed medically necessary.
Preventive Care: Things like screenings, vaccines, and annual wellness visits are covered under Medicare Part B.
Clinical Research: Some costs for approved clinical research studies that may help you access new treatments are approved.
Ambulance Services: Medicare Part B covers emergency ground or air transportation when other options could endanger your health.
Mental Health & Substance Abuse Services: This includes outpatient therapy, counseling, psychiatric visits, and treatment for substance use disorders.
Diagnostic Tests & Screenings: Lab work, X-rays, MRIs, and screenings like mammograms or colonoscopies.
Durable Medical Equipment (DME): Medically necessary equipment like wheelchairs, walkers, oxygen supplies, and hospital beds.
What Does Medicare Part B Not Cover?
While Medicare Part B has a fairly broad spectrum of covered services and equipment, there are several things not included. Part B does not cover:
Routine Dental Care: Dentures, fillings, and routine cleanings are not covered.
Vision & Hearing Care: Eye exams, glasses, and hearing aids are also excluded from Medicare Part B.
Cosmetic Procedures: Elective surgeries and treatments for appearance that are not medically necessary.
Most Prescription Drugs: Outpatient prescription medications are not covered; for this, you'll need Part D or Medicare Advantage.
Routine Foot Care: Podiatry services for routine maintenance are excluded unless deemed medically necessary.
Medicare Part B Eligibility
Similar to Medicare Part A, any individual who is age 65 or older is eligible for Medicare Part B.
Individuals who are not yet 65 years of age can still quality for Original Medicare (Medicare Parts A and B) if you have Lou Gehrig's Disease (ALS) or End-Stage Renal Disease.
There are a few other considerations to take:
You must also be a U.S. citizen or lawful permanent resident who has lived for at least 5 years in the United States.
You may be automatically enrolled in Medicare Part B if you have been receiving Social Security Disability Benefits (SSDI) for 24 months or Railroad Retirement Board benefits.
Medicare Part B Costs
When budgeting your healthcare spend, there are several costs to note for Medicare Part B:
- Premiums: This is the monthly payment you will make in order to receive coverage from the Social Security Administration. Unlike Medicare Part A (which is premium-free for most), Medicare Part B always has a premium.
- Deductible: This is the amount you must pay before your insurance “kicks in” and helps cover the remainder of the cost of treatment.
- Out-of-Pocket Costs: These are the amounts you will be responsible for that are not paid for by Medicare.
Medicare Part B Premiums
In 2025, Medicare Part B has a standard premium of $185 per month for most beneficiaries. However, this premium is adjusted based on individual income resulting in a value called the Income-Related Monthly Adjusted Amount, or IRMAA:
| Individual Tax Return With Modified Adjusted Gross Income | Joint Tax Return With Modified Adjusted Gross Income | Total Monthly Premium |
|---|---|---|
≤ $106,000 | ≤ $212,000 | $185 |
> $106,000 and ≤ $133,000 | > $212,000 and ≤ $266,000 | $259 |
> $133,000 and ≤ $167,000 | > $266,000 and ≤ $334,000 | $370 |
> $167,000 and ≤ $200,000 | > $334,000 and ≤ $400,000 | $480.90 |
> $200,000 and ≤ $500,000 | > $400,000 and ≤ $750,000 | $591.90 |
≥ $500,000 | ≥ $750,000 | $628.90 |
Keep in mind that these premiums might not be exactly correct if you miss your Initial Enrollment Period (IEP) for Medicare Part B. When you miss the IEP, a penalty is incurred. This penalty increases the longer you wait to sign up, and is active as long as you have Medicare Part B.
Medicare Part B Deductible
The Medicare Part B deductible as of 2025 is $257 annually. You will pay this deductible once per year before Original Medicare begins to pay for your healthcare.
Medicare Part B Out-of-Pocket Costs
For most Medicare-covered services, you will typically pay 20% of the approved amount after meeting the deductible. There is no out-of-pocket maximum for Medicare Part B. Let's break down the coverage amounts by type of service:
Clinical Lab Services & Home Health Care: There is $0 of out-of-pocket costs for covered clinical laboratory and home health care services.
Durable Medical Equipment (DME): 20% of the Medicare-approved amount for durable medical wheelchairs, walkers, hospital beds, and other DME.
Inpatient Hospital Stays: Though Part B does not cover the hospital stay itself, it does cover 20% of the Medicare-approved amount for doctor services received while you're inpatient.
Mental Health Care: There is a $0 out-of-pocket cost for annual depression screenings. Post-screening, you will pay 20% of the Medicare-approved amount for diagnostic or treatment doctor visits.
- Note: If services are received at a hospital outpatient clinic or department, you may have to pay an additional amount to the hospital.
Outpatient Hospital Care: 20% of the Medicare-approved amount for doctor and other health care providers' services.
- Note: You will also pay the hospital for each service you get in a hospital outpatient setting (excluding certain preventive services).
A general theme you will notice is that the additional hospital copayments required for outpatient hospital services mean you may pay more for services received in a hospital than for the same service received in a doctor's office.
How to Apply for Medicare Part B
Medicare enrollment operates on specified enrollment periods, so before you learn how to apply for Medicare Part B, it's vital to understand when you should be ready to apply.
Note: If you are already receiving Social Security or Railroad Retirement benefits, you will have been automatically enrolled into Medicare Part B once you turn 65.
When to Enroll in Medicare Part B
Medicare enrollment relies on a series of enrollment periods. If you aren't automatically enrolled in Medicare Part B, you will likely enroll during the Initial Enrollment Period (IEP). The IEP is different for everyone depending on their birthday. This period happens one time, and lasts for seven months: the three months before your 65th birthday month, the month of your 65th birthday, and the three months after your 65th birthday month.
Enrollment in Medicare Part B can also be delayed; this is an option if the following applies to you:
You are still receiving healthcare from your or your spouse's employer (whether that be because you are still working or because of an employer-provided retirement plan).
- You must enroll in Medicare Part B within eight months of losing that coverage to avoid penalties.
If you have chosen to delay enrollment in Medicare Part B, you must submit a request for a Special Enrollment Period (SEP) whenever you are ready to enroll. The length and timing of SEPs vary depending on each individual situation.
How to Enroll in Medicare Part B
Ready to enroll in Medicare Part B? There are several options available to you when it comes to enrolling:
Visit the Social Security Administration's Medicare enrollment page online; once you're there, navigate down to “Apply Online” under “Sign Up for Medicare”.
- Here, you can also check the status of your application once enrollment is complete.
The Social Security Administration also has a Medicare hotline (+1 800-772-1213). When you call, specify the plan or plans in which you'd like to enroll.
In-person appointments for enrollment are also available. This is a great option if you need assistance with the application from a real person.
Looking to extend your healthcare coverage past Original Medicare? Online Medicare plan comparison and recommendation tools like Healthpilot can help! Just visit our Find Plans portal and get started by giving us a little information about yourself.
With Healthpilot, you can explore Medicare Part C (Medicare Advantage), Medicare Part D (Drug Coverage), or Medigap (Supplemental Coverage).
Learn More About Original Medicare
Medicare Part B FAQs
Medicare Parts A and B, when combined, form Original Medicare. They work together, but they cover very different types of care.
- Medicare Part A is Hospital Insurance, covering inpatient stays and related services (skilled nursing, hospice, home health care).
- Medicare Part B is Medical Insurance, focusing on outpatient services and Durable Medical Equipment (DME).
Most people choose to enroll in both, as this provides more coverage for some of your healthcare needs.
Those who are already enrolled in Medicare Part B, you still have the opportunity to add Part A if you are eligible. The good news is, many people qualify for premium-free Part A if you or your spouse worked and paid Medicare taxes for at least 10 years.
To add Part A to your Medicare plan, apply through the Social Security Administration (similar to how you applied for Part B); online, over the phone, or in-person. Your Medicare Part A coverage will be added to your Medicare benefits once it is approved.
Although Medicare Part A is premium-free for most beneficiaries, the same is not true for Medicare Part B. Everyone pays a monthly premium for Part B; the exact amount, however, varies depending on your (or you and your spouse's combined) income level.
For those with limited income and resources, there are additional assistance programs available both at the state and federal levels. Click here to explore Medicare Savings Programs.
Enrolling in Medicare is not mandatory, but highly recommended for seniors who need healthcare coverage. If you don't enroll in Medicare when you are first eligible (during your Initial Enrollment Period), you could face permanent late enrollment periods. This could mean Medicare Part B is more expensive for the entirety of the time you have it.
Additionally, without Medicare Part B, you would be financially responsible for covering payment for outpatient services (doctor visits, preventive care, and more). This can add up quickly, which is why it's so important to mind your enrollment periods and weigh your future healthcare needs against your current coverage.
No, $170 was the standard premium for 2022. The Medicare Part B premium changes yearly, in addition to being higher for individuals with higher incomes due to the Income-Related Monthly Adjustment Amount (IRMAA).
Premium cost updates are published annually by the Centers for Medicare & Medicaid Services (CMS), so checking current numbers before budgeting is paramount.
Medicare Part B is akin to traditional medical insurance, covering outpatient medical services. This includes routine doctor visits, screenings, lab tests, outpatient treatments, mental health services, and durable medical equipment.
Medicare Part B helps fill the gaps left by Part A, which only covers inpatient care. Having Part B is essential for accessing the doctors and outpatient services you'll likely need most often in retirement.
For most people, yes; having both Part A and Part B provides the foundation of Medicare coverage, often referred to as “Original Medicare.”
By enrolling in both Medicare Parts A and B, you will have coverage for inpatient and outpatient services, meaning you'll have fewer gaps in your healthcare. Enrolling in both Parts A and B is strongly recommended to avoid penalties and ensure more comprehensive protection.
No. Unlike Part A, which may be premium-free if you’ve paid Medicare taxes and worked for at least 10 years, Part B always comes with a monthly premium.