Key Takeaways

• Medicare Part B provides broad medical coverage, but it does not cover everything. You will need to plan for out-of-pocket expenses like deductibles, coinsurance, and services Medicare doesn’t include.

• Understanding what is and isn’t covered in 2025 helps you avoid surprise bills and prepare for additional insurance if needed.

A Clear View of Medicare Part B in 2025

Medicare Part B is a major component of Original Medicare and focuses on outpatient medical services. If you’ve enrolled in it, you’re already benefiting from coverage that can greatly reduce your costs for doctor visits, preventive screenings, and durable medical equipment.

But while Part B is robust, it’s not all-encompassing. In 2025, there are still some costs and services that you must manage on your own or through additional coverage.

What Medicare Part B Covers in 2025

Medicare Part B steps in to cover medically necessary services and preventive care. Here’s what that includes:

Doctor Visits and Outpatient Care

• Office visits with general practitioners or specialists

• Second opinions before surgery

• Some telehealth visits

Preventive Services

• Annual wellness visits

• Vaccinations: flu, COVID-19, pneumonia, hepatitis B

• Cancer screenings: mammograms, colonoscopies, lung cancer screenings

Lab Tests and Diagnostic Imaging

• Blood work

• X-rays, MRIs, CT scans

• EKGs and other diagnostic tests

Mental Health Services

• Outpatient therapy (individual and group)

• Psychiatric evaluations and medication management

• Depression screening once per year

Durable Medical Equipment (DME)

• Walkers, wheelchairs, hospital beds

• Nebulizers and oxygen equipment

Ambulance Services

• Emergency ground transportation

• Air ambulance when medically necessary and no ground alternative is available

Certain Prescription Drugs (Limited Situations)

• Drugs administered in a doctor’s office (e.g., chemotherapy or some injectable medications)

• Immunosuppressive drugs for organ transplant recipients if the transplant was covered by Medicare

Costs You’re Responsible for Under Part B

Even with comprehensive coverage, Medicare Part B still leaves you with some financial responsibilities. Here’s a look at what you pay in 2025:

Monthly Premium

• The standard monthly premium in 2025 is $185.

• If your income is above a certain threshold, you may pay more due to Income-Related Monthly Adjustment Amounts (IRMAA).

Annual Deductible

• The Part B deductible is $257 for 2025.

• You must pay this amount out-of-pocket before Medicare starts to pay for most services.

Coinsurance

• After meeting your deductible, you pay 20% of the Medicare-approved amount for most Part B services.

• Medicare pays the remaining 80%.

Excess Charges

• Some doctors do not accept Medicare assignment. They may charge up to 15% more than the Medicare-approved amount.

• You’re responsible for these excess charges unless you have additional coverage that helps pay them.

Non-Covered Services

Medicare Part B does not cover:

• Routine dental care, dentures

• Routine vision exams and eyeglasses (except post-cataract surgery)

• Hearing aids and exams for fitting them

• Long-term custodial care (help with daily activities like bathing and dressing)

• Cosmetic procedures

Timeline: When Coverage Begins and Ends

Understanding when your Part B coverage kicks in helps you avoid lapses or delays in care.

• If you sign up during your Initial Enrollment Period (which starts three months before your 65th birthday and ends three months after), coverage begins the first of the month you turn 65.

• If you delay enrolling and use a Special Enrollment Period (for example, if you’re covered by employer insurance), your coverage begins the month after you sign up.

• If you miss your enrollment window entirely, you’ll have to wait for the General Enrollment Period (January 1 to March 31) and your coverage won’t begin until July 1.

How Preventive Services Save You Money

Preventive services under Part B are often fully covered—meaning you owe nothing if your doctor accepts Medicare. These services are a key part of lowering long-term costs and catching illnesses early:

• Vaccinations help prevent hospital stays

• Screenings like colonoscopies detect cancer early

• Annual wellness visits establish a care plan and check for risk factors

These services reduce complications and costly interventions down the line.

Combining Part B With Other Coverage

Since Part B leaves you with 20% coinsurance and doesn’t cover certain services, many people look into options to fill those gaps:

Medicare Supplement Insurance (Medigap)

• Helps pay your Part B coinsurance, deductibles, and excess charges

• Doesn’t cover services Part B excludes (like dental or vision)

Medicare Advantage Plans

• These are bundled plans that include Part A, Part B, and often Part D

• May offer additional benefits like dental or hearing, but you still pay the Part B premium

Medicaid (if eligible)

• Covers most out-of-pocket Medicare costs

• May also include dental and vision, depending on your state

What to Ask Before Receiving Services

You should always check a few things before scheduling care:

• Is this provider enrolled in Medicare? Providers who don’t accept Medicare assignment can charge you more.

• Will Medicare cover this service? If not, you’ll pay out-of-pocket.

• Do I need prior authorization? Some services or equipment may require approval before Medicare pays.

Pitfalls That Can Cost You More

Even with Medicare, a lack of preparation can lead to financial surprises. Here’s how to avoid them:

• Assume coverage means full coverage – It doesn’t. You’ll usually owe 20%.

• Ignore your deductible – You must pay $257 before Medicare covers outpatient services.

• Miss your enrollment window – Late enrollment leads to penalties and delayed coverage.

• Forget excess charges – Some providers charge more than Medicare allows.

• Skip preventive care – It’s free and can save you significant costs down the line.

Planning for the Gaps

Medicare Part B is essential, but it’s not designed to cover everything. If you’re retired or planning to retire soon, here’s how to prepare for what Part B won’t pay for:

• Set aside savings for dental, vision, and hearing care

• Consider a Medigap plan if you want to avoid high out-of-pocket costs

• Check if you’re eligible for programs that help cover Medicare expenses

Your Next Steps Toward Smarter Coverage

Knowing exactly what Medicare Part B covers—and what it doesn’t—is essential for planning your healthcare in 2025. Don’t wait until you’re surprised by a bill to learn the limits of your coverage.

If you have questions about supplementing your Part B coverage or understanding your out-of-pocket costs, speak to a licensed insurance agent listed on this website who can walk you through your options.