Key Takeaways

• Medicare Part B covers a wide range of medically necessary services—but it doesn’t pay for everything. You are still responsible for deductibles, coinsurance, and sometimes the full cost of certain services.

• In 2025, the standard monthly premium for Part B is $185, with a deductible of $257. But these figures only scratch the surface of your total out-of-pocket costs.

What Medicare Part B Covers in 2025

Medicare Part B is your gateway to outpatient medical coverage. It plays a critical role in your overall Medicare benefits, offering protection for services not covered under Part A. However, understanding what it doesn’t cover is just as important as knowing what it does.

Outpatient Medical Services

Part B primarily covers:

• Doctor visits (including specialists)

• Outpatient medical procedures

• Preventive services like screenings and vaccines

• Laboratory tests and X-rays

• Durable medical equipment (DME) such as wheelchairs and walkers

• Mental health services (outpatient only)

• Certain home health services

This coverage is essential, especially as more care shifts from hospitals to outpatient settings. Yet every service you receive is subject to rules about how much Medicare will pay and what you’ll owe.

Preventive Services and Screenings

Many preventive services are fully covered by Medicare Part B—provided your provider accepts Medicare assignment. These include:

• Annual wellness visits

• Flu and pneumonia shots

• Mammograms, colonoscopies, and other screenings

While these services may come at no extra charge, follow-up care or treatments stemming from them may result in out-of-pocket costs.

The True Cost of Part B Coverage

While the headline figures of premiums and deductibles are commonly discussed, they don’t reflect the complete financial picture. Here’s a closer look at the less visible costs.

Premiums and Deductibles in 2025

In 2025:

• The standard monthly premium is $185.

• The annual deductible is $257.

These apply to most beneficiaries, although higher-income individuals may pay more under the Income-Related Monthly Adjustment Amount (IRMAA).

20% Coinsurance—and What It Means

Once you meet the deductible, you are typically responsible for 20% of the Medicare-approved amount for most services. There’s no annual out-of-pocket cap under Original Medicare, which means:

• Frequent doctor visits can add up.

• High-cost procedures can leave you with sizable bills.

• Durable medical equipment purchases can result in large personal expenses.

For example, if a covered service costs $1,000, you would still owe $200 after Medicare pays 80%.

No Cap on Out-of-Pocket Spending

Unlike many private insurance plans, Medicare Part B has no annual limit on your out-of-pocket spending. If you experience a chronic illness, undergo surgery, or need ongoing therapies, your 20% share can stretch well into the thousands.

This lack of financial protection surprises many people and makes exploring supplemental coverage a smart move.

What Medicare Part B Doesn’t Cover

To fully prepare, it’s important to understand the gaps in Part B coverage. These uncovered services may require other forms of insurance or come entirely out of your own pocket.

Prescription Drugs

Part B only covers certain drugs administered in a clinical setting (like chemotherapy). It does not cover:

• Maintenance prescriptions you pick up at a pharmacy

• Over-the-counter medications

To get outpatient drug coverage, you typically need to enroll in a separate Medicare Part D plan or explore other options.

Routine Dental, Vision, and Hearing Services

Medicare Part B excludes:

• Routine dental exams, cleanings, and dentures

• Eye exams and glasses (except after cataract surgery)

• Hearing tests and hearing aids

These are some of the most common healthcare needs for older adults—yet you must pay for them out-of-pocket unless you have additional coverage.

Long-Term Care

Custodial care in a nursing home or assisted living facility is not covered under Part B. Even if you need help with daily activities like bathing or eating, Medicare does not pay for long-term stays.

Only medically necessary skilled nursing care, under very specific conditions, is partially covered by Medicare.

Hidden Costs That Catch Beneficiaries Off Guard

Even if you understand the basic structure of Medicare Part B, there are several areas where the costs can escalate unexpectedly.

Surprise Billing

If your doctor doesn’t accept Medicare assignment, they can charge up to 15% more than the Medicare-approved amount. This “excess charge” is your responsibility.

You can avoid this by confirming whether your provider accepts Medicare assignment before scheduling services.

Hospital Observation Status

You might be in the hospital for days, but if you’re classified as under “observation” rather than being formally admitted, Part A won’t cover it. That means Part B steps in—and so do coinsurance charges.

This subtle classification has major financial implications. Observation status can:

• Trigger higher out-of-pocket expenses

• Disqualify you from receiving Medicare-covered skilled nursing care afterward

Ambulance Services

Medicare Part B does cover ambulance transportation—but only when deemed medically necessary and to the nearest appropriate facility. If the situation is not considered an emergency or you request a specific hospital, you could be liable for part or all of the cost.

Durable Medical Equipment (DME)

Medicare covers 80% of the approved amount for DME, but:

• You still owe 20%

• Items must be medically necessary and prescribed by a Medicare-participating provider

• If you rent equipment, you’ll have ongoing monthly costs

Some DME suppliers do not accept Medicare, which may leave you responsible for the full charge.

Managing the Financial Gaps in 2025

Understanding what’s covered—and what’s not—is only the first step. Protecting yourself from high medical costs involves proactive planning.

Consider a Supplemental Option

Medicare Supplement Insurance (Medigap) can help cover the costs Original Medicare doesn’t—like coinsurance and excess charges. However, the timing of enrollment is key.

The best time to enroll in Medigap is during your Medigap Open Enrollment Period, which begins when you’re 65 or older and enrolled in Part B. During this six-month window, you cannot be denied coverage or charged more due to health status.

Outside of this window, you may be subject to medical underwriting.

Understand Part D Enrollment Timing

Because Part B doesn’t cover most prescription drugs, adding Part D at the right time is crucial. If you miss your Initial Enrollment Period (IEP), you may face permanent late enrollment penalties and gaps in drug coverage.

The IEP spans seven months: three months before, the month of, and three months after you turn 65 or become eligible.

Review Your Annual Notice of Change (ANOC)

If you have any additional coverage, reviewing your Annual Notice of Change each fall helps you:

• Stay on top of plan changes

• Adjust your coverage as your health needs evolve

• Avoid surprise costs in the new year

Open Enrollment runs from October 15 to December 7 each year. Mark it on your calendar.

Use Preventive Services

Take advantage of the fully covered preventive services under Part B. Detecting issues early often leads to lower overall costs and better outcomes.

These services include:

• Annual wellness exams

• Diabetes screenings

• Cancer screenings

• Vaccines like flu, COVID-19, and hepatitis B

How to Be Financially Prepared for Part B in 2025

Medicare Part B provides essential coverage, but it’s far from all-inclusive. The burden of coinsurance, lack of an out-of-pocket maximum, and gaps in coverage for drugs, dental, and long-term care make additional planning critical.

To avoid financial surprises:

• Budget for ongoing out-of-pocket costs

• Verify providers accept Medicare assignment

• Learn the classifications like observation status

• Consider pairing Part B with other Medicare options

If you’re unsure what fits your situation, help is available.

Explore Your Options With Confidence

Understanding Medicare Part B in 2025 means looking beyond premiums and deductibles. It’s about knowing what’s included, where the gaps are, and how to protect yourself from long-term financial strain.

If you’d like personalized advice based on your current or future coverage needs, speak with a licensed agent listed on this website. They can help you make informed choices that align with your health and budget priorities.