What Part B Actually Covers (and What It Doesn't)
Medicare Part B is the medical insurance piece of Original Medicare—it's different from Part A, which covers hospital stays. If you're on Medicare or thinking about it, Part B is worth understanding because it shapes what you'll pay for doctor visits, tests, and outpatient care.
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Part B covers doctor visits, whether that's your primary care doctor or a specialist. It pays for lab work and blood tests ordered by your doctor. If you need an X-ray, ultrasound, or other imaging done outside a hospital, Part B typically covers 80 percent of that cost (after you've met your yearly deductible). Physical therapy, occupational therapy, and speech therapy all fall under Part B when ordered by a doctor for a medical reason.
Mental health services are covered—both therapy appointments and psychiatric care. Preventive services like screenings for cancer, heart disease, and diabetes are included. If you need durable medical equipment like a wheelchair, walker, or oxygen equipment, Part B pays a share. Ambulance rides to the hospital are covered. Even some outpatient surgery at a hospital or surgery center falls under Part B rather than Part A.
What Part B does NOT cover is important to know. It doesn't pay for routine dental work, vision exams, eyeglasses, or hearing aids (though some preventive hearing screenings may be covered). Prescription drugs you pick up at a pharmacy are not Part B's responsibility—that's where Part D comes in. Long-term care in a nursing home isn't covered. Cosmetic surgery, unless it's repair after injury or disease, isn't included. Certain experimental treatments may not be covered unless they're part of an approved clinical trial.
Practical takeaway: Before assuming Part B pays for something, check the specific service. Medicare's official website has a searchable tool that tells you what's covered and what your share of the cost would be. This saves you from unexpected bills.
Understanding Part B Costs: Premiums, Deductibles, and Coinsurance
Part B isn't free, and the costs work in three different ways. Most people think of "premium" as the monthly payment, but there's also a yearly deductible and then coinsurance (your percentage of the bill after the deductible). It helps to think of these as separate pieces so you can plan your healthcare spending.
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The monthly premium for Part B varies by income. In 2024, the standard premium was $164.90 per month for people with income under $97,000 a year (if you're single). If your income is higher, you pay more—sometimes significantly more. The government uses tax returns from two years ago to calculate this, so there's often a lag. If your income drops—because you retire or have a major life change—you can request a review and potentially lower your premium.
The yearly deductible is the amount you pay out of your own pocket before Part B starts paying its share. In 2024, that deductible was $240. Once you've paid $240 in covered services in a calendar year, you've met your deductible. Then Part B pays 80 percent of approved charges for most services, and you pay the remaining 20 percent (called coinsurance).
Here's a real example: You go to your doctor for a visit. The approved charge is $150. You haven't met your deductible yet, so you pay the full $150. Later in the year, you have a blood test. The approved charge is $200. You've now paid $350 total, which exceeds your $240 deductible. So you owe 20 percent of $200, which is $40. Medicare's share is the other $80.
There's another important number: the Part B out-of-pocket maximum. In 2024, if you received services from providers who accept Medicare assignment (which most do), your costs for Part B services were capped at $2,000 for the year. Once you hit that cap, Medicare pays 100 percent of your remaining Part B services that year. Unassigned providers work differently and can charge more.
Practical takeaway: Create a simple spreadsheet tracking what you've paid toward your deductible each year. Once you hit that $240, your coinsurance percentage kicks in. Knowing where you stand helps you decide whether to schedule elective procedures before or after meeting your deductible—sometimes the timing matters financially.
Part B Enrollment: When You Can Sign Up and What Happens If You Miss the Window
Part B isn't automatic for everyone, and when you sign up matters. Unlike Part A, which most people are automatically enrolled in once they turn 65, Part B requires an active choice. There are specific time periods called "enrollment periods" when you can sign up, and missing them can cost you money down the road.
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Your Initial Enrollment Period begins three months before the month you turn 65 and ends three months after. That's a seven-month window. If you sign up during the three months before your birthday month, your coverage starts the month you turn 65. If you sign up in your birthday month, coverage starts the following month. If you wait until after, there's a one-month delay. Most people should sign up before or during their birthday month to avoid any gaps.
If you miss your Initial Enrollment Period, there's a General Enrollment Period from January 1 to March 31 each year. But here's the catch: if you sign up during General Enrollment, your coverage doesn't start until July 1. That means you have a gap with no Part B coverage from when you turn 65 until July. Plus, you'll pay a late enrollment penalty for as long as you have Part B—an extra 10 percent on your premium for each full year you were eligible but didn't sign up.
There's an important exception: if you're still working at 65 and have health insurance through your job, you may not need to sign up for Part B yet. This is called having "creditable coverage" from your employer. You can delay Part B without penalty as long as you sign up within eight months of losing that job-based coverage. But you must contact Social Security to let them know you're delaying based on work coverage—not doing so can still trigger the late penalty.
Another exception is the Special Enrollment Period. If you have a major life event—like losing job-based insurance, moving to a new state, or having a significant change in income—you may qualify to enroll outside the normal windows. You typically have 60 days from the qualifying event.
Practical takeaway: Mark your calendar for three months before you turn 65. That's when to contact Social Security or Medicare to enroll. If you're still working with employer coverage, document it and notify Social Security proactively. The late penalty compounds every year, so getting the timing right saves real money over time.
Original Medicare Part B vs. Medicare Advantage: What the Difference Means for You
Part B is one piece of Original Medicare. But you have another major choice: you can use Original Medicare with Part B, or you can choose Medicare Advantage instead. Understanding the difference helps you pick the approach that fits your health needs and budget.
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Original Medicare is fee-for-service. Medicare pays doctors and hospitals directly for services you receive. You have Part A (hospital) and Part B (medical). You can see any doctor or specialist anywhere in the United States who accepts Medicare—there are no networks. This flexibility appeals to people who travel, who have strong relationships with specific doctors, or who live in rural areas where network-based plans might be limited.
Medicare Advantage is an alternative way to get Parts A and B. It's offered by private insurance companies that contract with Medicare. These plans usually have networks—preferred doctors and hospitals you should use, with higher costs if you go outside. Many Medicare Advantage plans include extra benefits that Original Medicare doesn't: dental, vision, hearing, and sometimes fitness or meal programs. These plans often have lower premiums than Original Medicare premiums plus Medigap (supplemental insurance).
The trade-off in Medicare Advantage is structure and limits. You may need referrals to see specialists. Some services require prior authorization, meaning the plan has to approve them first. You may have higher copays ($25 for a doctor visit, $50 for a specialist, for example, rather than 20 percent coinsurance). And because these are networks, they change year to year—your doctor might leave the