Key Takeaways

• Medicare Part B covers the bulk of your routine medical services, but the costs add up fast—especially with annual premiums, deductibles, and coinsurance.

• In 2025, the standard monthly premium for Part B is $185, and the deductible is $257, but many people pay more depending on their income.

Understanding What Part B Actually Covers

Medicare Part B is designed to handle your everyday health care needs. While Part A focuses mostly on hospital care, Part B is where most of your interaction with the health system happens. This includes doctor visits, preventive screenings, diagnostic tests, outpatient procedures, durable medical equipment, mental health services, and more.

You are generally responsible for three main types of costs under Part B:

• Monthly Premium: Most people pay a standard amount, though it increases if your income is above a certain threshold.

• Annual Deductible: You must pay this out-of-pocket before Medicare starts covering services.

• Coinsurance: After meeting your deductible, Medicare typically covers 80% of approved services, leaving you responsible for the remaining 20%.

What You Pay in 2025

Let’s break down the actual costs you face in 2025:

• Monthly Premium: The standard premium is $185. However, if your modified adjusted gross income (MAGI) from two years ago (2023) exceeds $106,000 (individuals) or $212,000 (joint filers), you’ll pay more under the Income-Related Monthly Adjustment Amount (IRMAA).

• Annual Deductible: $257 in 2025. You pay this before your Part B benefits kick in.

• Coinsurance: After meeting your deductible, you’re responsible for 20% of Medicare-approved amounts for most services.

It’s important to note that these costs are recurring. You don’t just pay the deductible once per illness or injury—it resets every calendar year.

Income Can Change Your Part B Premium

The more you earn, the more you pay for Part B. Medicare uses your IRS tax return from two years prior to assess your income. If you earned more than the standard threshold, IRMAA adds a surcharge to your monthly premium.

Medicare reassesses this annually. If your income decreases due to retirement, divorce, or other life events, you can request a reconsideration using form SSA-44. But without such an appeal, your 2025 premium is based on your 2023 income.

You Can’t Skip Part B Without Risk

If you don’t sign up for Part B when you’re first eligible—and you don’t have creditable coverage through an employer—you’ll face late enrollment penalties. These penalties are permanent.

• The penalty: A 10% increase in your premium for every 12-month period you were eligible but didn’t enroll.

• When it applies: It’s added to your monthly premium for life, unless you qualify for an exception.

Most people become eligible when they turn 65, and the Initial Enrollment Period lasts for 7 months: 3 months before your birthday month, the month of, and 3 months after.

If You Delay Enrollment, Coverage Isn’t Immediate

Miss your initial window? You’ll have to wait for the General Enrollment Period (January 1 to March 31 each year), with coverage starting July 1. This delay can leave you without outpatient coverage for months.

The timing is crucial. Even if you’re healthy now, Part B covers vital services like:

• Emergency ambulance transport

• Diagnostic imaging (like MRIs or CT scans)

• Chemotherapy and dialysis

• Outpatient surgeries and post-op care

Preventive Care Under Part B—And What It Saves You

Medicare Part B covers a wide range of preventive services at no cost to you if your provider accepts assignment. These include:

• Annual wellness visits

• Flu shots and other vaccines

• Mammograms and colonoscopies

• Cardiovascular disease screenings

• Diabetes screenings

While these services might seem minor, they can catch health problems early—before they become major medical events. Avoiding complications saves you money in the long run.

The 20% Coinsurance Adds Up Quickly

Let’s say you have a $5,000 outpatient procedure. Once your $257 deductible is met, you’re still responsible for 20% of the remaining cost—meaning $947 out-of-pocket. And that’s just one procedure.

There’s no out-of-pocket maximum under Original Medicare Part B. Unless you have supplemental coverage (like a Medigap policy), your costs can escalate rapidly depending on your care needs.

What Happens If You Don’t Pay?

Part B premiums are usually deducted from your Social Security benefits. But if you’re not yet receiving Social Security, you must pay directly—usually quarterly.

Failure to pay premiums on time results in cancellation of coverage. Reinstatement is difficult and not guaranteed. Medicare will send notices before termination, but once canceled, you may have to wait for the next General Enrollment Period to reapply—and penalties will apply.

Coverage Limits and What Isn’t Included

Despite how essential Part B is, it doesn’t cover everything. You’ll need to plan ahead for services such as:

• Prescription drugs (covered under Part D)

• Dental, vision, and hearing care

• Long-term custodial care

These gaps often surprise enrollees. It’s why many people consider additional coverage, even though that comes at an extra cost.

Why It’s Critical to Review Your Part B Costs Every Year

Your Medicare costs can change yearly—not just due to premium or deductible increases, but also due to income changes and possible IRMAA adjustments. Every fall, the federal government announces updated costs for the upcoming year.

Open Enrollment (October 15 to December 7) is your opportunity to review and adjust your coverage. Even though Part B is part of Original Medicare, your overall strategy may involve:

• Enrolling in a Part D plan for drug coverage

• Considering supplemental coverage for the 20% coinsurance

• Reviewing any changes to income that affect IRMAA

Missing the Fine Print Could Mean Higher Costs

Many people assume Medicare will automatically cover all their health expenses after 65. In reality, failing to understand how Part B works—and how much it costs—leads to unexpected bills.

It’s not just about knowing your premium. You need to know what services require coinsurance, how your income affects your costs, and what’s not included.

Smart Planning Reduces Surprises

When you plan early and understand what Part B covers and costs, you can reduce the risk of high out-of-pocket expenses. Consider these planning steps:

• Estimate your annual health care usage and total potential out-of-pocket costs

• Revisit your income annually to manage IRMAA charges

• Explore supplemental coverage options for the 20% that Part B doesn’t cover

• Stay informed about annual Medicare cost updates

Medicare Part B Isn’t Optional for Most—And It’s Not Cheap

By 2025, the reality is clear: Medicare Part B is the part you use most—and the one that drains your wallet if you’re unprepared. With the lack of an out-of-pocket maximum and a 20% coinsurance on nearly everything, skipping the details isn’t an option.

For most people, the smartest step is to treat Part B like a cornerstone of your retirement plan. It’s not just paperwork—it’s your access to care.

If you need help understanding how these costs impact your situation or want help with supplemental coverage, speak with a licensed agent listed on this website for professional guidance tailored to you.