Navigating the world of health insurance can be an overwhelming experience, but understanding what Medicare covers and does not cover is critical for older Americans seeking comprehensive medical coverage.
Here’s what you need to know about Medicare Part B.
Coverage Under Medicare Part B
Medicare Part B covers outpatient medical services, including visits to the doctor, preventive care, some medical equipment and certain home health services. Beneficiaries typically pay a monthly premium for Part B coverage, along with coinsurance or copayments for covered services after the deductible is met.
Common medical services covered by Medicare Part B include:
— Annual wellness checks
— Ambulatory surgical center services
— Chemotherapy and other cancer treatments
— CPAP devices and therapy
— Cognitive assessment and care plan services
— Diabetes equipment, supplies and therapeutic shoes
— Doctor and specialist visits
— Durable medical equipment, including hospital beds, oxygen, walkers and wheelchairs
— Emergency department services
— Hearing and balance exams
— Kidney dialysis and supplies
— Laboratory tests
— Outpatient medical, surgical and rehabilitation services, including physical therapy, occupational therapy and speech-language therapy
— Mental health outpatient care
— Telehealth visits
— Transplants and immunosuppressive drugs
— Travel care, with certain exceptions when you’re traveling outside of the U.S.
Just as important is preventive care. Some preventive services covered are:
— Bone mass measurements (once every 24 months)
— COVID-19, flu and other vaccines
— Diabetes self-management training
— Diagnostic imaging tests, such as X-rays, MRIs, CT scans and EKGs
— Screenings for diseases such as diabetes, cancer, kidney disease, cardiovascular diseases and depression
— Counseling to prevent tobacco use
— Sexually transmitted infection testing
Medicare Part B also covers other medical care that may come as a surprise, such as:
— Bariatric surgery
— Clinical research studies
— Nutrition therapy
How much Medicare covers the above may vary; some treatments come with certain coverage limitations.
[Read: 5 Steps for Picking a Medicare Plan.]
What Doesn’t Medicare Part B Cover?
Medicare Part B does not cover:
— Hospital insurance, which is covered by Medicare Part A, including:
— Inpatient hospitalization
— Skilled nursing facility stays
— Some home health care
— Hospice
— Prescription drug coverage, which is covered by Medicare Part D
— Dental and vision care and hearing aids, which some Medicare Part C plans, also known as Medicare Advantage plans, cover
— Long-term care
Medicare Part B Costs Explained
Like most employer-based or health care exchange insurance plans, Medicare uses premiums, deductibles
and out-of-pocket expenses — such as copayments — to help cover the cost.
Premiums and deductibles change yearly and are typically announced for the following year in mid-September. However, out-of-pocket costs per service remain consistent and are typically 20% of the total cost.
Deductible
Under original Medicare, which consists of Part A and Part B, if the Part B deductible applies, you must pay all costs until you meet it. The yearly deductible in 2025 is $257.
Out-of-pocket expenses
After you meet your deductible, Medicare begins to pay its share, and you typically pay 20% of the Medicare-approved amount of the service. Keep in mind that there’s no yearly limit on what you pay out-of-pocket if you have original Medicare.
To help manage those out-of-pocket costs, many sign up for a Medicare supplement plan, also known as Medigap, which helps cover some of those costs.
Premiums
The standard monthly Part B premium in 2025 is $185. Be aware that your premium may increase depending on your income.
Higher-income earners must pay a surcharge, called income-related monthly adjustment amount (IRMAA), on top of the standard Part B premium. This surcharge is based on income reported two years prior.
Premiums start rising as income increases as follows:
These amounts are likely to change in 2026.
Are there any hidden costs of Medicare Part B?
In order to get the full cost benefits of Part B, you must go to a provider that accepts Medicare. Be aware that doctors who do not accept Medicare can charge up to 15% above the Medicare-approved amount for the service, so it is in your best interest to double-check.
When a doctor agrees to accept Medicare, it is called “accepting assignment,” which means they agree to the Medicare-approved amount for full payment and cannot charge you more for these services.
Medicare.gov has a search tool that can help you find providers who accept assignment and other services, such as hospitals, home health services, dialysis facilities and medical equipment suppliers. You can also search for providers near you with U.S. News’ Best Doctors and filter by insurance type, including Medicare.
Another hidden cost is the late enrollment penalty for Part B, which is an extra 10% added to your monthly premium for each year you delay signing up. This penalty isn’t a one-time charge but an addition to your part B premium for as long as you have it.
If you’ve had active employer group health coverage since turning 65, and that coverage ended within the past eight months, you’re eligible to enroll in Part B without a penalty. This qualifies as a special enrollment period. A special enrollment period allows you to enroll in or change your coverage outside the usual windows, without penalties, due to certain life events or changes in circumstances.
[Read: How to Avoid Paying a Medicare Late Enrollment Penalty]
Affording Medicare
Medicare premiums and out-of-pocket costs often catch retirees by surprise. According to a survey by the Senior Citizens League, an Alexandria, Virginia-based nonpartisan group advocating for seniors, Medicare-eligible members pay a significant portion of their total household income toward health care costs. Among 2,275 respondents to a June 2023 survey, 34% of respondents spent 16% to 29% of their income on medical expenses.
“Affording health care expenses, even with help from Medicare, is still a struggle for many seniors,” says Mary Johnson, a Medicare policy analyst with the Senior Citizens League.
Medicare Part B is only free if you have a low income and are enrolled in one of the Medicare Savings Programs for financial assistance. Eligibility for these programs vary by state.
“The qualification process is more accessible in some states due to elevated income limits or the absence of asset requirements,” Johnson says.
Typically, your Part B premium is taken directly from your monthly Social Security benefits. If you don’t receive these benefits, or if they aren’t enough to cover the premium, Medicare will send you a bill.
Medicare Part B Eligibility
Medicare Part B is available to:
— Americans 65 and older
— Younger individuals who have received Social Security Disability benefits for 24 months
— Those who have end-stage renal disease or amyotrophic lateral sclerosis (ALS)
To qualify for Medicare, you must be a U.S. citizen or legal permanent resident who has lived in the United States for at least five continuous years.
[READ: How Do I Know When I’m Eligible for Medicare?]
Applying for Medicare Part B
If you are already receiving Social Security payments, you can receive Medicare parts A and B, and the government automatically enrolls you prior to your 65th birthday (though if you don’t need Part B, you can decline it).
If you are 65 or older, still working and not yet drawing Social Security, the key determinant for enrolling in Medicare is the size of your employer. If the company has fewer than 20 employees, you should enroll during the initial enrollment period — which stretches from three months before you turn 65 to the month of your birthday and three months afterward.
There are two reasons for enrolling, according to Edd Staton, a retirement expert and co-author of the book “Mission: Rescue Your Retirement”:
— Your small group insurer might be able to refuse to pay any portion of claims that Medicare would have paid.
— Whenever you do enroll in Medicare, you will be subject to a lifelong late enrollment penalty on Part B that continues to increase every year you delay.
“If you are contributing to a health savings account, you cannot enroll in Medicare because to contribute pre-tax dollars you cannot have health insurance other than a high-deductible health plan,” Staton explains.
However, if you have employer coverage, you can sign up for Medicare without a penalty after you retire. Once you’re enrolled, keep in mind that you are also no longer eligible to contribute to a health savings account.
There are a few enrollment windows where you can sign up or switch Medicare plans. The most important being the open enrollment period from October 15 to December 7, where anyone can sign up for next year’s coverage.
To enroll in Medicare, visit the Social Security website or check out Medicare.gov for additional resources.
Bottom Line
Part B is the portion of original Medicare that covers outpatient medical services like visits to the doctor, preventive care, lab tests and durable medical equipment. To get the full benefit of Part B, visit providers who accept Medicare as those who don’t can charge up to 15% more.
Medicare Part B has a standard monthly premium of $185 in 2025, with higher-income individuals paying more due to the IRMAA surcharge. The 2025 annual deductible is $257, after which you typically pay 20% of the Medicare-approved cost for services. There is no yearly limit on out-of-pocket expenses unless you have supplemental coverage like a Medigap plan.
A common hidden cost is the late enrollment penalty — an extra 10% on your premium for every year you delay signing up, which lasts as long as you have Part B. You can avoid this penalty if you’ve had qualifying employer health coverage and enroll within eight months of losing it under a special enrollment period.
Depending on your circumstances, you may be enrolled automatically or will need to manually enroll in Medicare, so you do not incur penalties. Check your enrollment status with Social Security, which administers Medicare and handles the sign-up process. Financial assistance may be available through Medicare Savings Programs, depending on your income and your state’s eligibility rules.
Find the Best Medicare Advantage and Medicare Part D Plans With U.S. News
If you’re considering options other than original Medicare, start your search for the best plan for you with U.S. News’ Best Insurance Companies for Medicare Advantage 2025 and Best Medicare Part D Companies. You can look for and compare Medicare Advantage, Medicare Part D, bundled Medicare Advantage and Part D plans and Medigap plans near you with the U.S. News search and compare tool.
To determine the top-rated insurance companies, U.S. News consulted with Medicare experts to identify and weigh the most important quality measures for Medicare Advantage consumers, applied these weights to data from the Centers for Medicare & Medicaid Services and then adjusted for enrollment.
More from U.S. News
How to Test Whether You’re Aging Well
How to Help Your Elderly Parents Start Decluttering and Downsizing
Medigap vs. Medicare Advantage: Which Should You Buy?
Medicare Part B: Costs and Coverage originally appeared on usnews.com
Update 08/14/25: This story was previously published at an earlier date and has been updated with new information.
