As you approach retirement age, it’s crucial to have a solid understanding of your healthcare options. One of the most essential components of your healthcare coverage is Medicare, a federal program that provides health insurance to individuals aged 65 and older, as well as some younger individuals with disabilities. In this comprehensive guide, we’ll focus on Medicare Part B coverage and costs, helping you navigate this important aspect of your healthcare plan.
What does Medicare Part B Cover?
Medicare Part B primarily covers your outpatient, medical services, including doctor visits, preventive care, medical supplies, and medically necessary equipment. Here is a list of included services under Part B:
- Doctor visits and consultations
- Tests and diagnostics (Xrays, labs, screenings)
- Outpatient treatments and therapies
- Preventative care and Vaccinations
- Ambulance services and emergency care
- Durable medical equipment
- Mental health
- Some Chemotherapy Drugs
Does Medicare Cover Telehealth?
What are Part B Costs?
Part B does have a monthly premium, deductible, and coinsurance costs. Here are the costs associated with Part B coverage:
Part B Monthly Premium: $185 per month for most people in 2025. The amount can change each year. Some people could pay less or more than this monthly amount if they are low income or high-income earners. If you make more than $106,000 individually or $212,000 jointly then you will be subject to an Income Related Monthly Adjustment Amount (IRMAA). See how much your IRMAA will be here.
Part B Deductible and Coinsurance: After you meet your deductible, you will pay 20% of the Medicare-approved medical expenses. There is no maximum out-of-pocket for Part B. This means there is not a cap on how much you will spend on your Part B expenses each year.
Did you know that Medicare Advantage plans do have a maximum out-of-pocket on costs to limit the amount you could spend each year? Speak with our licensed agents to learn more!
When am I Eligible for Part B?
To be eligible for Medicare Part B, you must be 65 years or older, or under 65 with certain disabilities. People with end-stage renal disease (ESRD) may also qualify for Part B. You must be a U.S. citizen or a legal resident and lived in the United States for five consecutive years. If you have been a resident for less than 5 years but are married to a citizen, then the 5-year continuous residency may not apply. Read more about How Non-U.S. Citizens Can Qualify for Medicare.
When can I enroll in Part B?
Medicare Part B enrollment periods and method depend on when and how you first become eligible, if you are still working and have creditable coverage, or if you are already receiving social security benefits. If you are enrolling when you are first eligible due to age, then you need to enroll during your Initial Enrollment Period (IEP). This period runs 3 months before your birthday month, the month of your birthday, and three months after your birthday month.
This IEP is the same for people who become eligible after 24 months of receiving Social Security Disability Insurance. The seven-month period is around their 25th month of disability.
It is generally recommended to enroll in Medicare Part B during your Initial Enrollment Period to avoid penalties and ensure continuous coverage. If you are working past your initial eligibility period and maintain creditable coverage through your employer group plan, then you may be able to delay Part B and have a Special Enrollment Period when you retire or lose coverage. See our blog on How to Transition to Medicare from Employer-based Health Insurance?
What if I miss my Initial Enrollment Period?
If you miss your Initial Enrollment Period and did not have a Special Enrollment Period then you must wait until the General Election Period to enroll in Medicare. This period runs from January 1st to March 31st each year, allowing individuals who didn’t enroll in Medicare during their Initial Enrollment Period to sign up for Part A and/or Part B. Coverage will start the month after you sign up. You will likely have a penalty added to your monthly premium. Learn more about the General Enrollment Period here.
If you want to avoid penalties, be sure to reach out to a licensed agent 6 months before your initial eligibility so we can help you determine when you need to enroll.
How do I enroll in Part B?
Are you already receiving Social Security benefits? Then you will be automatically enrolled in Part A and Part B when you become eligible. If this happens but you want to delay Part B due to other creditable coverage, then you will need to decline Part B through Social Security. If you are not receiving Social Security benefits, then you will need to manually enroll yourself. You enroll through Social Security either online at https://www.ssa.gov/medicare/sign-up, in person at your local Social Security office, or via phone at 800-772-1213. For more information on how to sign up for Medicare, see our Complete Guide to Enrolling in Medicare Part A and B.
Part B is a critical component of Medicare, but is only one part of Medicare and alone does not provide complete coverage. It works in tandem with Part A (hospital insurance) and Part D (prescription drugs) to provide more comprehensive coverage. As you navigate Medicare Part B, seek guidance from a licensed insurance professional to ensure you make informed decisions regarding your healthcare coverage. They can help answer questions and compare coverage options to ensure you have the coverage you need.
