Key Takeaways

• Medicare Part B covers essential outpatient services, but understanding enrollment rules and costs can help you avoid unnecessary penalties.

• Knowing how Medicare Part B works with other insurance plans ensures you make informed choices about your healthcare coverage.

What Does Medicare Part B Cover?

Medicare Part B plays a crucial role in your healthcare by covering outpatient services, preventive care, and doctor visits. Here’s a breakdown of what’s included:

• Doctor visits and outpatient care – Covers consultations, specialist visits, and treatment from licensed healthcare providers.

• Preventive services – Includes screenings, vaccinations, and wellness visits to help detect health issues early.

• Durable medical equipment (DME) – Helps cover wheelchairs, walkers, and oxygen supplies when medically necessary.

• Mental health services – Offers coverage for therapy, counseling, and psychiatric evaluations.

• Emergency ambulance transportation – Covers emergency ambulance rides when no other transportation is safe.

• Limited prescription drug coverage – While Part B does not replace Medicare Part D, it covers certain medications administered in a clinical setting, such as chemotherapy drugs.

How Much Does Medicare Part B Cost in 2025?

Medicare Part B is not free, and your monthly premium depends on your income. Here’s what you should expect in 2025:

• Standard monthly premium – $185 per month.

• Annual deductible – $257 before coverage begins.

• Coinsurance – Once your deductible is met, you typically pay 20% of Medicare-approved services.

• Income-related adjustments – Higher earners may pay more based on their modified adjusted gross income (MAGI) from two years prior.

To ensure you understand your exact costs, check your Social Security statement or consult a licensed agent for more details.

When and How Should You Enroll in Medicare Part B?

Enrollment in Medicare Part B depends on your situation. Here’s when you should sign up:

• Initial Enrollment Period (IEP) – This seven-month period starts three months before you turn 65, includes your birth month, and continues for three months after.

• Special Enrollment Period (SEP) – If you have employer coverage, you may delay enrollment without penalty and sign up within eight months of losing that coverage.

• General Enrollment Period (GEP) – Runs from January 1 to March 31 each year, with coverage beginning July 1. Late penalties may apply if you missed earlier enrollment opportunities.

What Happens If You Delay Enrollment in Medicare Part B?

Delaying Medicare Part B without qualifying for a Special Enrollment Period can result in costly penalties. Here’s what you need to know:

• Late enrollment penalty – You may pay an extra 10% on your premium for each full 12-month period you were eligible but did not enroll.

• Penalty duration – The penalty is lifelong and added to your monthly premium as long as you have Part B.

• Employer coverage exception – If you have health insurance through an employer with 20+ employees, you can delay Part B without facing penalties. However, once that coverage ends, you must enroll within eight months to avoid penalties.

Can You Have Other Insurance Alongside Medicare Part B?

Yes, Medicare Part B can work alongside other forms of insurance. Understanding how these plans coordinate is key to maximizing your benefits.

• Employer or retiree coverage – If your employer provides health insurance, it may act as primary coverage, with Medicare Part B as secondary.

• Veterans Affairs (VA) benefits – Medicare does not coordinate with VA benefits, meaning you’ll need to receive care from VA facilities to use VA coverage.

• Medicaid – If you qualify for Medicaid, it can help cover Medicare Part B premiums and cost-sharing expenses.

What Services Are Not Covered by Medicare Part B?

While Medicare Part B covers a broad range of services, it does not include everything. You may need additional coverage for:

• Prescription drugs – You will need Medicare Part D or other drug coverage for most outpatient medications.

• Dental, vision, and hearing care – Routine dental exams, eyeglasses, and hearing aids are not covered under Part B.

• Long-term care – Medicare does not pay for extended nursing home stays or custodial care.

• Cosmetic procedures – Surgeries or treatments not deemed medically necessary are not covered.

To fill these gaps, you may need additional insurance options. A licensed agent listed on this website can help you explore the right plan for your needs.

Making Sense of Medicare Part B for a More Confident Future

Medicare Part B is a vital part of your healthcare coverage, but knowing when to enroll, what it covers, and how much it costs can help you make informed decisions. Whether you’re approaching your 65th birthday or already enrolled, staying informed about your options ensures you maximize your benefits without unexpected surprises. For professional advice tailored to your situation, reach out to a licensed agent listed on this website today.