Key Takeaways

• Medicare Part B is not free, and you are responsible for monthly premiums and out-of-pocket costs, which can vary based on your income.

• Delaying enrollment in Part B when you’re first eligible can result in lifelong penalties unless you qualify for a special enrollment period.

Understanding Medicare Part B: What It Covers and What It Doesn’t

Medicare Part B is the component of Original Medicare that covers medical services and outpatient care. While it’s a critical part of your healthcare coverage, it does not cover everything. Knowing the scope of its benefits can help you plan for medical expenses.

What Medicare Part B Covers:

• Doctor visits – Routine check-ups, specialist consultations, and medically necessary visits.

• Preventive services – Screenings, vaccines, and wellness visits to help detect or prevent illness.

• Outpatient care – Includes hospital outpatient procedures, diagnostic tests, and certain surgeries.

• Durable medical equipment (DME) – Wheelchairs, walkers, and other medically necessary equipment.

• Emergency ambulance services – When transportation is necessary for a medical emergency.

What Medicare Part B Does Not Cover:

• Long-term care (such as nursing home stays beyond a short rehabilitation period)

• Dental, vision, and hearing care (routine services)

• Prescription drugs (covered separately under Medicare Part D)

Since Part B does not cover everything, you may need to explore additional coverage options for expenses like dental or prescription drugs.

The Cost of Medicare Part B in 2025: What You Need to Budget For

Medicare Part B requires monthly premium payments, and costs can change annually. In 2025, the standard premium for Medicare Part B is $185 per month. However, if your income exceeds a certain threshold, you may pay a higher premium due to the Income-Related Monthly Adjustment Amount (IRMAA).

Other Out-of-Pocket Costs Include:

• Annual deductible – Before Medicare Part B starts covering costs, you must pay a $257 deductible for the year.

• Coinsurance – After meeting your deductible, you generally pay 20% of the Medicare-approved amount for covered services.

• Excess charges – If your doctor does not accept Medicare’s approved amount as full payment, you could be responsible for an additional 15% in excess charges.

Proper budgeting is essential to avoid unexpected medical expenses, especially if you require frequent doctor visits or outpatient care.

Enrolling in Medicare Part B: Avoid Late Penalties

When Should You Enroll?

You become eligible for Medicare Part B at age 65. The best time to sign up is during your Initial Enrollment Period (IEP), which lasts seven months—starting three months before your 65th birthday, including your birth month, and ending three months after.

What Happens If You Miss Your Initial Enrollment?

If you don’t enroll in Part B during your IEP and you don’t qualify for a Special Enrollment Period (SEP), you could face a late enrollment penalty:

• The penalty is 10% of the standard premium for every 12-month period you went without coverage.

• This penalty is permanent and added to your premium every month for as long as you have Part B.

A Special Enrollment Period (SEP) allows you to delay Part B enrollment without a penalty if you have employer-sponsored health coverage. You have eight months after losing employer coverage to sign up.

Medicare Part B and Employer Coverage: Do You Need Both?

If you are still working at age 65 and have employer-provided health insurance, you may wonder whether you need Medicare Part B. The answer depends on your employer’s size:

• If your employer has 20 or more employees, you can delay Part B without penalty as long as you remain covered by your job-based insurance.

• If your employer has fewer than 20 employees, Medicare becomes your primary coverage, and you should enroll in Part B to avoid gaps in coverage.

If you delay Part B due to employer coverage, be sure to sign up during your Special Enrollment Period to avoid penalties.

Medicare Part B and Medicare Advantage: Can You Have Both?

Many people enroll in Medicare Advantage (Part C) to get additional benefits beyond what Original Medicare offers. However, you must first be enrolled in both Medicare Part A and Part B to join a Medicare Advantage plan.

Key Points About Medicare Advantage and Part B:

• You must continue paying your Part B premium even if you have Medicare Advantage.

• Medicare Advantage plans can offer extra benefits such as dental, vision, and prescription drug coverage.

• You typically need to use network providers for covered services, unlike Original Medicare, which allows access to any provider that accepts Medicare.

Understanding how Medicare Advantage works alongside Part B can help you make an informed decision about your coverage options.

What If You Travel Often? Medicare Part B and Out-of-Country Coverage

Medicare Part B provides coverage within the United States, but it offers very limited benefits if you travel outside the country. Standard Part B does not cover routine care or emergency treatment abroad. However, there are a few exceptions:

• Medicare may cover services in Canada or Mexico if you experience a medical emergency and a foreign hospital is closer than a U.S. hospital.

• Certain Medicare Supplement (Medigap) policies provide limited emergency coverage abroad, typically covering 80% of emergency medical costs after a small deductible.

If you plan to travel frequently, you may want to consider additional international health coverage options.

Staying Informed: Medicare Part B Changes Every Year

Medicare is not a static program—it evolves over time. In 2025, there have been several updates, including:

• Higher premiums and deductibles compared to 2024.

• New Medicare payment models that could affect provider reimbursements.

• Expanded preventive care services covered under Part B.

To stay informed about changes to Medicare Part B each year, review the Medicare & You handbook or check the official Medicare website.

How to Make Smart Medicare Decisions for 2025

Understanding the details of Medicare Part B can save you from unexpected medical expenses. From knowing when to enroll to budgeting for premiums and out-of-pocket costs, making informed decisions now can prevent financial surprises later.

If you need personalized guidance on your Medicare options, get in touch with a licensed agent listed on this website for professional advice tailored to your situation.