Medicare Part B: Cost, Coverage, and Eligibility

Medicare Part B covers medical insurance costs for seniors 65 and older. It pays for 80% of outpatient services, including doctor visits, medical equipment, and home healthcare.

Medicare Part B: Pros and Cons

It’s part of Original Medicare, but unlike Part A, Medicare Part B is not free. Premiums are $185 per month (Learn More: Medicare Advantage vs. Original Medicare). Beneficiaries must also meet a deductible and pay any copays or coinsurance costs associated with their plan.

Use this guide to compare Medicare costs and learn how you can avoid paying for Medicare Part B. If you still have questions, call (855) 634-0435 to speak with a licensed insurance agent about your Medicare needs. You can also enter your ZIP code to get started.

What Medicare Part B Covers

What does Medicare Part B cover? Medicare Part B is the medical insurance part of Original Medicare plans. It partially covers visits to your doctor, outpatient hospital services, and care from other licensed healthcare providers, including mental health and substance abuse specialists.

It also pays for durable medical equipment (DME), such as wheelchairs, canes and walkers, hospital beds, oxygen equipment, and blood sugar monitors.

In some cases, Part B will cover certain outpatient prescription drugs associated with DME. Screenings and annual vaccines are also covered by Medicare Part B (Read More: Best Endocrinologists That Accept Medicare).

Part B is the medical insurance side of traditional Medicare plans. It covers medically necessary outpatient care and equipment, including:

• Ambulance Services: Emergency and medically necessary transportation to hospitals or skilled care facilities
• Durable Medical Equipment (DME): Wheelchairs, walkers, hospital beds, oxygen supplies, and similar items deemed medically necessary by a doctor
• Doctors & Specialists: Outpatient care, including checkups, vaccines, and treatment from approved providers
• Outpatient Prescription Drugs: Medications administered in a clinic or medical facility, but not at home
• Mental Health Services: Outpatient psychiatric care as prescribed by a doctor, including counseling and some preventive screenings

More than half of seniors use Medicare Part B to pay for outpatient care after surgery, routine doctor visits, and preventative care like vaccines and disease management.

However, Medicare Part B isn’t free. You’ll need to pay a monthly premium along with meeting your annual deductible. You will have to meet your deductible and Medicare Part B coinsurance and copays before outpatient medical services are covered, so read our guide if you need help to pay for what your health insurance won’t cover.

What Part B Doesn’t Cover

Medicare Part B handles most of your outpatient care needs, like routine appointments and preventative care, but it doesn’t cover all of your health insurance needs. It won’t pay for routine dental, vision, or hearing care, and it doesn’t cover prescription drugs or hospital stays.

Medicare Part B Exclusions

Many of these things are covered by other types of Medicare insurance plans. If you need these additional coverages, compare Medicare Advantage or Medicare Supplemental Insurance (Medigap) plans to find the right Medicare Part B provider for you.

Medicare Part B Cost

How much will Medicare Part B premiums be this year? Beneficiaries pay $185 a month for Medicare Part B coverage, but Social Security benefits can often cover some or all of your premium.

Medicare Part B: Cost, Coverage & Enrollment Details

Medicare Part B deductibles must be met once a year. After that, beneficiaries are responsible for 20% copay and coinsurance payments to compensate for what Medicare Part B doesn’t cover

Medicare Copay, Coinsurance, & Premium Breakdown

The amount you pay for Part B also depends on your income. To qualify for $185 monthly premiums, income must fall below $106,000 for individuals and $212,000 for couples.

Medicare Part B Coverage Cost by Income

Can you get Medicare Part B for free? Some beneficiaries can get low-cost Part B coverage through Medicare Savings Programs (MSPs). Find out how to qualify in our guide on how much Medicare costs.

For example, the Qualified Medicare Beneficiary (QMB) program helps pay for your premium, deductible, coinsurance, and copays, allowing you to have Part B coverage without out-of-pocket expenses.

Medicare Part B Eligibility

Who’s eligible for Medicare? Seniors turning 65 are automatically eligible for Medicare Part B benefits up to three months before their 65th birthday. People under 65 may also qualify if they’ve received Social Security Disability Insurance (SSDI) for 24 months or have End-Stage Renal Disease (ESRD) or ALS.

Do I need Medicare Part B if I have insurance? Not necessarily, especially if you are still employed and insured under a group health plan. However, Part B is typically more affordable than standard health plans, and you may have to pay a Medicare Part B late enrollment penalty fee if you miss your initial sign-up period.

How to Enroll in Medicare Part B

Follow the steps to determine your enrollment period and fill out the appropriate Medicare Part B form to get covered. You can also speak with a licensed insurance agent with any questions about your Medicare coverage by calling (855) 634-0435.

Step #1 – Find Out Your Medicare Enrollment Period

Medicare Part B eligibility depends on your birthday month. The first of the month, three months before your 65th birthday, is when the Initial Enrollment Period (IEP) for Medicare starts (Learn More: How to Sign Up for Medicare).

Medicare Part B Enrollment Periods

If you miss the IEP, you can sign up during the General Enrollment Period (GEP), but you will be charged a penalty. The Medicare Part B late enrollment penalty increases with every year you were eligible but didn’t sign up.

Step #2 – Complete the Enrollment Application

Visit the Social Security Administration (SSA) website to fill out the Medicare Part B application form. You’ll need to include your birth certificate, SSN, current health insurance coverage, and proof of legal residence (typically a utility or insurance bill).

Once online, you’ll have the option to sign up for Original Medicare or Medicare Part B only. If you have Medicaid coverage, you may be automatically or already enrolled in Part A. In that case, you’ll only need a valid email address and your current Medicare number to complete the Medicare Part B application.

Step #3 – Receive Your Medicare Card in the Mail

It typically takes 30 days to process Medicare Part B applications, and you’ll receive your Medicare card in the mail within a month. The card lists the start date of your coverage and should include a Medicare Part B provider phone number.

Read More: Best Gastroenterologists That Accept Medicare

Alternatives to Medicare Part B

What happens if I don’t want Medicare Part B? While there’s no true replacement for Medicare Part B, there are alternatives in how you get that kind of outpatient coverage.

• Medicare Advantage Plans: Also known as Medicare Part C, which includes all Part B benefits plus extras. Call (855) 634-0435 to speak with a licensed insurance agent about your options.
• Employer/Union Health Benefits: Some retirees keep employer or union retiree health benefits instead of or in addition to Part B.
• VA Health Benefits: Veterans can use VA health benefits, but VA coverage doesn’t replace Medicare and can limit provider choice.

If you skip Medicare Part B coverage, you’ll need another plan that covers doctor visits, tests, and outpatient treatments, or risk paying out-of-pocket for most outpatient care.

Medicare Advantage is the most common alternative. It offers a unique opportunity to combine Medicare Part A and Part B with the other types of health coverage you might need based on your medical history.

What You Need to Know About Medicare Part B

Medicare Part B is the second half of Original Medicare that covers doctor visits, outpatient care, preventive services, durable medical equipment, and ambulances.

Medicare Part B Overview

Why is Medicare Part B so expensive? Because it covers a wide variety of medical services, from outpatient care to medical equipment and ambulance rides, your Medicare Part B premium is higher than other Medicare plans that strictly cover hospital stays or prescription drugs.

The SSA offers Medicare Savings Programs (MSPs) that can help eligible seniors with limited income pay their Medicare bills, but many policyholders opt for Medicare Advantage plans that include additional benefits.

If you have any questions regarding your plan or payments, call the Medicare Part B phone number at (855) 634-0435 to speak with a licensed insurance agent.