Medicare Part B

Medicare Part B is part of Original Medicare and covers medical services and preventive care. It includes doctor visits, screenings, vaccines, and wellness checkups. On your Medicare ID card, it's labeled "Medical."


Part B generally covers two types of services:

● Medically necessary services – Tests, treatments, or supplies needed to diagnose or treat a condition.

● Preventive care – Services like flu shots and screenings to help prevent or detect illnesses early.


Most preventive services are free if you visit a provider who accepts Medicare’s payment terms (assignment).

Medicare Part B

What does Medicare Part B cover?

Medicare Part B covers outpatient care, including preventive services like vaccines, cancer screenings, and lab tests. It also helps pay for mental health care and medical equipment.


While Part A covers hospital stays, Part B pays for services received in the hospital, such as X-rays, surgeries, dialysis, chemotherapy, and injected medications.

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Coverage Not Included in Medicare Part B

Medicare Part B does not cover routine dental, vision, or hearing care. It also won’t pay for cosmetic procedures, alternative treatments (like acupuncture or homeopathy), or most prescription drugs and vaccines.


Part B helps with some medical costs, including doctor visits, lab tests, outpatient care, limited home health care, therapy, and certain medical supplies—but it only pays part of the bill.

How much does Medicare Part B cost?

In 2025, Medicare Part B costs include a monthly premium of $185 and an annual deductible of $257. After meeting the deductible, Medicare covers 80% of approved services, leaving you responsible for the remaining 20%. If you receive benefits from Social Security, Railroad Retirement, or the Office of Personnel Management, your premium is automatically deducted from your payments. Otherwise, you'll receive a bill, payable online via Medicare Easy Pay. Keep in mind, premiums and deductibles may change annually.

What copays does Medicare Part B have?

Part B does not have any copays.

Who is eligible for premium-free Part B?

If you qualify for premium-free Medicare Part A, you’re also eligible for Part B. Most people pay a monthly premium for Part B, but low-income individuals or those with Medicare and Medicaid may get free Part B through the Medicare Savings Program.

You qualify for Medicare Part B if:

● You are a U.S. citizen or legal resident who has lived in the U.S. for over five years

● You are 65 or older

● You have received Social Security Disability (SSDI) for two years

● You have End-Stage Renal Disease (ESRD)

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Enrolling in Medicare Part B

If you’re already receiving Social Security benefits before turning 65, you’ll be automatically enrolled in Medicare Parts A and B, and your Medicare card will arrive a month before your birthday.


If you aren’t receiving benefits yet, you’ll need to apply yourself online or by calling the Social Security office.


Your Initial Enrollment Period (IEP) lasts seven months—starting three months before your 65th birthday and ending three months after. If you don’t enroll during this time and don’t have other health coverage, you may have to pay a penalty.


You can avoid penalties if you qualify for a Special Enrollment Period (SEP), which applies if you had other creditable health insurance and delayed enrolling.


If you're not yet receiving retirement benefits, MAC Insurance can help you enroll in Medicare. You can sign up online at SSA.gov, visit your local Social Security office, or give us a call for guidance.

Reinstating Medicare Part B

If your Medicare Part B stops because of missed payments, you’ll need to reapply to get your coverage back.

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MEDICARE PART B

Original Medicare (Parts A and B) doesn’t cover all medical expenses. Beneficiaries have additional options to help with healthcare costs. Our experienced agents can walk you through these choices and help you find the right additional coverage for your needs.

ADDITIONAL QUESTIONS TO BE ADVISED ON:

Does Medicare Part B cover prescription drugs?

Medicare Part B covers some injected medications, but most prescription drugs are covered under Part D.

When does my Part B coverage start after I apply?

If you're not automatically enrolled and miss your Initial Enrollment Period, it may take 30-60 days for your application to be approved.

Do I need to pay the Part B deductible before receiving treatment?

Your doctor bills Medicare first, and then Medicare sends you a bill for the deductible.

Do I need to pay the Part B premium if I have a Medicare Advantage plan?

Even with a Medicare Advantage plan, you still need to pay the Part B premium. Some plans may offer a discount on this premium.

Do I still need to pay for Part B if I have other health insurance?

If you have creditable health insurance, you can delay Part B without a penalty. Just make sure your current coverage is considered creditable.

Is there a way to avoid paying the Part B premium?

You can avoid paying the Part B premium only if you qualify for a Medicare Savings Program.

Does everyone have the same Medicare Part B premium?

Most people pay the standard Part B premium, but those with higher incomes pay more, and those with lower incomes may pay less.

Is Part B eligibility determined by income?

No, Part B eligibility is based on age or disability, not income.

We are not connected with or endorsed by the United States government or the federal Medicare program. We do not offer every plan available in your area, and any information we provide is limited to those plans we do offer in your area. Please get in touch with Medicare.gov or 1-800-MEDICARE to get information on all your options.

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