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Medicare Part B

Smiling person with short hair wearing a light blue button-up shirt against a plain background.
Written by:
Aaron Garcia
Jason Kolkey Author Image GoHealth
Reviewed by:
Jason Kolkey
6 min read

Key Takeaways

  • Medicare Part BMedicare Part B is medical insurance that covers Medicare-approved services — such as medically necessary treatment and preventive services — and certain other costs, like durable medical equipment. Medicare Part B is part of Original Medicare. and Part AMedicare Part A is hospital insurance, which covers the care you receive while admitted to a hospital, skilled nursing facility, or other inpatient facility. Medicare Part A is part of Original Medicare. make up Original MedicareOriginal Medicare is a fee-for-service health insurance program available to Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance). .
  • Part B covers medical services, including treatment, preventive services, durable medical equipment, and vaccines.
  • Most U.S. adults become eligible to enroll in Medicare Part B the year they turn 65, but people with certain disabilities can sign up sooner.
  • The Part B monthly premiumA premium is a fee you pay to your insurance company for health plan coverage. This is usually a monthly cost. is income-based. Your Part B costs also include a deductibleA deductible is an amount you pay out of pocket before your insurance company covers its portion of your medical bills. For example: If your deductible is $1,000, your insurance company will not cover any costs until you pay the first $1,000 yourself. and out-of-pocket coinsuranceCoinsurance is the percentage of your medical costs that you pay after you meet your deductible. Your insurance company pays the remaining amount. For example: If you have a $1,000 medical bill and your coinsurance is 20%, you’ll pay $200. Your insurance company will cover the final $800. .

Original Medicare, the federally administered public health insurance program for U.S. adults who are 65 or older or have certain disabilities, has two parts. Medicare Part B covers medical services, while Medicare Part A is hospital insurance. Part B can help you access medically necessary outpatient treatments, preventive health screenings, vaccinations and immunizations, durable medical equipment, mental health care, and much more. 

Here’s what you should know about Medicare Part B coverage and costs.

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What Is the Difference Between Medicare Part A and Part B?

Parts A and B are the two halves of Original Medicare. Here’s an overview of how each contributes to your coverage:

Medicare Part A

Part A is hospital insurance to help cover the costs you incur when receiving inpatient medical care, which involves an overnight stay. In addition to hospital care, Part A can help with the costs of a stay in a skilled nursing facility as well as hospice and some home health care.

Services must be medically necessary for Medicare Part A to pay any portion. For example, cosmetic surgery that requires a hospital stay typically isn’t covered by Part A.

Medicare Part B

Part B is medical insurance for when you receive outpatient care that doesn’t require a stay in a hospital or other medical facility. Part B covers visits to a doctor, plus an extensive menu of preventive services that you can receive in an outpatient setting. Medicare Part B also covers durable medical equipment that you use at home. In other words, Medicare Part B covers much more than just the trips to your doctor’s office.

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When Do I Enroll in Medicare Part B?

Usually, people join Medicare Part A and B the year they turn 65. If this is your first chance to enroll in Medicare Part B, you can sign up during your Initial Enrollment Period (IEP).

For most people, the IEP starts three calendar months before the month you turn 65 and closes three calendar months after. However, if you were born on the first of the month, then your IEP starts four calendar months before the month you turn 65 and closes two calendar months afterward.  If you don’t have insurance from another source, not enrolling during your IEP means you’ll be stuck paying an enrollment penalty on your Part B premium when you do join.

Enrolling in Medicare Part B Before 65

Not everyone has to wait for 65 to enroll in Medicare Part B. Medicare allows certain beneficiaries to enroll early. If you’ve received disability-based Social Security for 24 months, you may be eligible. Those who have received Railroad Retirement Board (RRB) benefits for 24 or more months may also enroll before 65. Medicare will also extend Part B benefits to those living with certain conditions, including:

If you qualify for Medicare because of Social Security or RRB benefits, you may be automatically enrolled in Part A only. If so, you’ll need to sign up for Part B separately. To see if you need to enroll in Part B and you’re younger than 65, call the Social Security Administration. If you have rail benefits, contact the RRB.

Delaying Your Part B Enrollment

You may be able to delay your Medicare enrollment if you’re receiving group health benefits through an employer when you turn 65. Sticking with your employer’s plan may be more cost effective. You can stay on the plan and enroll in Medicare when it ends.

When you lose employer-provided insurance, a Special Enrollment Period will open. You have eight months to enroll in Original Medicare (Parts A and B) without incurring a Medicare late enrollment penalty.

The decision to delay your enrollment is more complicated than whether you can afford your current plan. Once you turn 65, your employer’s plan and Medicare will decide which side should pay the majority of your medical bills as the primary payer and which should pay the rest. Depending on the size of your company, letting Medicare pay its portion may provide more financial flexibility for all sides.

Employers with 20 or more employees generally take the role of primary payer when covering workers aged 65 and older. If you work for a larger employer, it likely makes sense to delay your enrollment until you lose your coverage.

Employers with fewer than 20 employees are generally the secondary payer behind Medicare, which helps relieve some of the cost burdens for small companies. If your group plan is the secondary payer, it will start covering what Part B does not. While you can delay your enrollment, it may not make sense if you work for a company with fewer than 20 employees.

How Do I Enroll in Medicare Part B?

Whether you’re approaching 65 or are looking to enroll for the first time during a Special Enrollment Period, there are several ways to sign up for Part B. Medicare enrollment happens through the Social Security Administration. If you’re already receiving Social Security benefits, you’ll be automatically enrolled when you turn 65.

Remember, you can begin the enrollment process as early as three calendar months before the month you turn 65 during your IEP. If you’re enrolling because your other coverage has ended, you have eight months to enroll without a penalty.

When you’re ready to enroll in Medicare Part B, you can do so:

  • Over the phone at 1-800-772-1213 (TTY 1-800-325-0778).
  • By filling out an online application with Social Security.
  • In-person at a local SSA office.

Do I Have to Pay for Medicare Part B?

Medicare beneficiaries generally have to pay for their Part B coverage. Costs include a monthly premium, an annual deductible, and coinsurance for certain services.  Here’s a quick overview:

What Is the Part B Premium?

Medicare Part B requires a monthly payment for coverage. Your Part B premium is your monthly payment for Medicare’s medical coverage. If you receive Social Security benefits, it’s typically withdrawn from your benefits each month. This differs from Medicare Part A, which is often provided at no monthly cost if you (or your spouse) worked 10 or more years.

The Part B premium in 2025 starts at $185 per month for adults making up to $106,000 per year. Couples who file a joint tax return can make up to $212,000. If you make more, you’ll have to pay an income-related monthly adjusted amount (IRMAA) on top of your monthly premium. For the highest earners, this can balloon your Medicare Part B premium. Most beneficiaries, however, pay the standard Part B premium amount.

What is the Part B deductible?

You’ll need to pay your entire Part B deductible before Medicare pays its portion of your medical bills. In 2025, that amount is $257. This applies to pretty much all Part B benefits, including medical services, durable medical equipment, and therapy services. Preventive services, however, are provided at no cost and do not count toward your deductible.

Your Part B premium and deductible can change from year to year. Medicare adjusts its rates based on data gathered by the Centers for Medicare & Medicaid Services (CMS). If you’re an Original Medicare beneficiary, you’ll receive notice of your rate adjustments in the mail.

What Are Part B Copays and Coinsurance?

Once you’ve paid your deductible, Medicare will begin to pay its portion for your Part B benefits. Medicare generally pays 80% of the cost for Medicare-approved services you receive that are deemed medically necessary by your doctor. You’re then responsible for paying the remaining 20%, or coinsurance. That means if your provider charges $100 for a doctor visit, Medicare will pay $80. You will pay the provider $20.

If you have Medicare Advantage (Part C), you’ll receive at least the same services and benefits that you’d get from Part B. Many insurance companies that provide Part C charge different amounts and use different payment structures than Medicare. One of these is a copayment; instead of charging beneficiaries a percentage of their Medicare-approved costs, copays are flat-rate payments. If you have Part C and receive a service that costs $500, you may only pay a copay.

Can I Review How Much I Pay For Part B?

If you’re an Original Medicare beneficiary, you’ll receive an overview of your Part B coverage in the mail every three months. This is known as a Medicare Summary Notice (MSN), and it has some very helpful information. It will list all the services and supplies prescribed in your name over that three-month timeframe, how much Medicare paid, and the amount billed to you. Your MSN is not a bill — think of it more as a statement that shows your current Medicare standing. Reviewing your MSN is also a great way to identify and prevent fraudulent services charged to Medicare in your name.

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What Does Medicare Part B Cover?

Medicare Part B covers a long list of treatments, services and equipment. These can include everything from cancer screenings and treatments to motorized scooters. For Part B to cover a treatment or service, it must be one of the following:

Medically necessary
Covered treatments and services are certified as by your doctor as needed to diagnose or treat a health condition.

Preventive
Aimed at preventing illnesses, these covered services aim to find health conditions early on to improve patient outcomes. These include screenings and immunizations.:

Here are a few examples of the services covered by Medicare Part B when medically necessary:

Medical services

Preventive services and screenings

Durable medical equipment

Vaccines and immunizations

Many of these services may be administered during a hospitalization. In this case, your service may be classified as “inpatient.” This can affect how Medicare covers and pays for these treatments. For example, chemotherapy that requires you to stay in a hospital or other facility may be covered by Part A. If so, you’ll have a different deductible and coinsurance rates.

Part B Drug Coverage

While you’ll need a Medicare Part D prescription drug plan to cover most medications, certain drugs are covered by Part B.  If you receive a drug in a medical setting like a doctor’s office, it may be covered by Part B. Medications that are used with durable medical equipment, for example, are often covered, as is chemotherapy received in outpatient therapy.

Here are some examples of drugs covered by Medicare Part B:

  • Insulin, when administered with an insulin pump that’s covered as durable medical equipment
  • Injectable drugs for osteoporosis
  • Erythropoiesis-stimulating agents
  • Blood clotting factors
  • Injectable drugs
  • Oral end-stage renal disease (ESRD) drugs
  • Intravenous and tube feeding
  • Intravenous Immune Globulin (IVIG) provided in-home

What Is Not Covered Under Medicare Part B?

Original Medicare typically doesn’t cover:

Long-term care

Also called custodial care, long-term care refers to assistance you may need to complete everyday tasks. These include dressing, bathing and eating. If this is the only service you need, Medicare typically won’t pay for it unless you receive custodial care as part of a larger service.

Prescription drugs

Part B covers medications in very limited instances. For most prescription drugs taken at home, you’ll need to enroll in a Medicare Prescription Drug Plan (Part D). Offered by private insurance companies, Part D plans must be added separately from Parts A and B. They also have their own premiums, deductibles and coinsurance.

Most dental care, including dentures

Medicare doesn’t consider dental care medically necessary. If you have Original Medicare and need dental services, including cavity fillings, checkups, or dentures, you’ll need to add standalone dental coverage.

Hearing and eye care

Medicare Part B doesn’t offer much help when it comes to your vision and hearing needs, either. Medicare won’t cover hearing tests or hearing aids, nor will it help pay for vision checks needed to fit you for glasses. In all of these cases, you’ll need to purchase separate, standalone coverage.

Cosmetic surgery

Medicare will not pay for procedures that are not medically necessary. While many cosmetic procedures may include intensive surgery and recovery periods, you’ll be responsible for paying all of your costs if you receive purely cosmetic care. The Part B deductible and coinsurance will not come into play.

If you need services that aren’t included in Medicare Part B, you can buy standalone policies, such as vision or dental insurance. You can also consider switching from Original Medicare (Parts A and B) to a Medicare Advantage (Part C) plan from a private insurance carrier. Medicare Advantage plans replace Original Medicare and offer at least the same coverage, but may include additional benefits.

FAQs

If you’re enrolled in Original Medicare (Parts A and B), your coverage is accepted anywhere in the country that accepts Medicare. If you’re traveling out of state and become sick, you are not limited to providers near your home. Medicare is run by the Social Security Administration, which is a federal program. Because of this, you can use your Medicare coverage across the nation.
Medicare has several options for beneficiaries that can’t afford their healthcare. The most recognized is Medicaid. Medicare and Medicaid are not the same things; Medicaid is health insurance for adults, children, and families with limited incomes and resources. Medicaid programs are run by the states and have different qualifications and benefits based on where you live. There are also times when Medicare and Medicaid will work together to cover your medical bills. This is known as dual eligibility.

If you need financial assistance but your income is too high for Medicaid, you may have other options. Medicare Savings Programs are state programs that receive federal funding to help beneficiaries pay for their Part B costs. If you qualify, you can get help paying for your Part B premium, deductible and out-of-pocket costs.
No; even though your monthly Part B premium payment is decided by factoring in both of your incomes, Medicare is an individual health policy only. There are no family plans as there are with regular health insurance. You and your spouse will need to enroll in, and pay for, your Part B policies separately.
The first thing will be to see if you qualify for a Special Enrollment Period. If not, you’ll need to enroll during your next available enrollment period. In this case, it’s the General Enrollment Period (GEP) for Part B. The GEP is held each year from January 1 to March 31. If you enroll during this time, your policy will become active on July 1.

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