What is Medicare Part B?

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Medicare is a federal government-sponsored health insurance program that includes Part A and Part B. While Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and certain home health care services, Medicare Part B covers doctor’s visits, outpatient surgical procedures, preventive services, and ambulance services.

It pays to better understand what Medicare Part B is, how it works, how to qualify and apply, and what is and isn’t covered.

What is Medicare Part B?

Medicare Part B falls under Original Medicare and is referred to as medical insurance.

The premium you pay is based on your income from two years prior. Most people with Medicare pay $174.70 monthly for Part B. Part A is free to most Americans — anyone who paid Medicare taxes for at least 40 quarters.

Medicare Part B fills in many coverage instances not covered by Part A, including doctors’ services, outpatient care, medical supplies, and preventive services.

Key Takeaways

Medicare Part B is the medical insurance portion of Original Medicare.
While Medicare Part A covers hospitalizations, Part B handles outpatient care like doctor’s appointments.
Part B beneficiaries pay a monthly premium, as well as an out-of-pocket costs, such as an annual deductible and coinsurance when they need health care services.

Who is eligible for Medicare Part B?

Medicare Part B health insurance coverage is available to people 65 and over, those who have been collecting Social Security Disability benefits for at least 24 months, people with end-stage renal disease or amyotrophic lateral sclerosis (ALS), those who receive retirement benefits from the Railroad Retirement Board.

People who are turning 65 have between three months before their 65th birthday month to three months after their 65th birthday month to sign up for Medicare coverage. According to CMS, if your birthday is on the first of the month, the initial enrollment period starts, “four months before you turn 65 and ends two months after the month you turn 65.” If you don’t sign up during that initial enrollment period, you may be charged a penalty once you get Medicare coverage. That penalty is 10% for every year that you didn’t sign up for coverage.

So, if you want until your 68th birthday to get coverage, you may pay 30% more for Part B premiums.

What does Medicare Part B cover?

Medicare benefits include hospital and outpatient coverage. Part B covers several services and procedures:

Doctors services, such as office visits
Outpatient surgical procedures
Durable medical equipment
Ambulance services
Lab work
Inpatient and outpatient mental health services
Some preventive services, such as flu shots

It may also pay for particular drugs administered in a clinical setting, such as insulin and osteoporosis injections.

What does Medicare Part B not cover?

Part B does not pay for hospital services if you’re admitted to a hospital as an inpatient. Those services fall under Part A.

“Many people who turn 65 are also surprised to learn that Medicare Part B does not cover certain ancillary services, including routine dental procedures and dental visits, vision services like eye exams, and hearing benefits such as hearing aids or exams for fitting hearing aids,” says Ari Parker, lead advisor for Chapter, a Phoenix-based Medicare advisory organization. “It also doesn’t cover most prescription drugs that would be filled at a pharmacy. To get drug coverage, Medicare beneficiaries typically purchase either a stand-alone prescription drug plan — also known as Medicare Part D — or opt for prescription drug coverage that’s offered through a Medicare Advantage plan.”

Long-term care also isn’t covered by Part B. This involves non-specialized personal care, with aid given for daily activities such as dressing, eating, bathing, or using the washroom.

Lastly, Part B won’t pay for certain services some carriers and/or insurance plans may otherwise cover like acupuncture and cosmetic surgery as well as certain vaccines, such as the shingles vaccine, adds Parker. However, limitations and exclusions apply and people should check with the carrier for plan-specific benefits.

How much is Medicare Part B?

Medicare Part B premiums are based on your annual income from two years prior reported on your IRS tax return; that means the 2024 cost for Part B is based on your earnings from 2022.

Medicare Part B premiums
File individual tax return	File joint tax return	File married & separate tax return	Monthly premium (in 2024)
$103,000 or less	$206,000 or less	$103,000 or less	$174.70
above $103,000 up to $129,000	above $206,000 up to $258,000	Not applicable	$244.60
above $129,000 up to $161,000	above $258,000 up to $322,000	Not applicable	$349.40
above $161,000 up to $193,000	above $322,000 up to $386,000	Not applicable	$454.20
above $193,000 and less than $500,000	above $386,000 and less than $750,000	above $130,000 and less than $397,000	$559.00
$500,000 or above	$750,000 or above	$397,000 or above	$594.00

Note that, aside from your premiums, you will usually pay approximately 20% of the Medicare-approved amount of covered medical services after you meet your Medicare Part B deductible, and as long as your doctor or health care provider accepts the Medicare-approved amount as full payment — called “accepting assignment.” The Medicare-approved amount is the payment amount that Original Medicare sets for a covered service or item. When your provider accepts assignment, Medicare pays its share and you pay your share of that amount.

“Be aware that there is no out-of-pocket maximum limit over a calendar year. This is why many people choose a Medigap plan or Medicare Advantage plan to help fill in the gaps in costs or services,” adds Parker.

What is the Medicare Part B deductible?

You also have to pay an out-of-pocket deductible every year if you need health care services.

This is the sum you must pay before Original Medicare kicks in for medical services. After your deductible is met, you usually pay for the 20% of the Medicare-approved amount when it comes to doctor services, outpatient services, applicable drugs administered in a clinical setting, and other services covered by Part B. That’s called coinsurance.

So, let’s say you already met your deductible for the year. You go for tests and the Medicare-approved amount is $400. Medicare Part B pays 80% of that amount, which is $320. You’re responsible for the rest, which is $80.

How to sign up for Medicare Part B

Many people don’t realize that they must opt into Medicare and officially enroll in Part B — unless you’re already receiving Part B benefits based on being disabled or are collecting Social Security benefits before your 65th birthday (in which case you will be auto-enrolled in Part B).

“The easiest and fastest way to enroll is through the Social Security website or to phone 800-773-1213,” says Maibor, managing director of Boston-headquartered Senior Benefits Boston.

When applying, be prepared to share information about yourself and supply documentation to verify your identity, such as a driver’s license, birth certificate, or proof of US citizenship.

How long does it take to get Medicare Part B after applying?

After you complete your application, you won’t be enrolled in Part B instantly or automatically.

“In general, Part B can take four to six weeks for Social Security to process and contact you with an approval,” notes Amanda Reese, a supervisor at insurance agency Hafetz and Associates.”Checking your My Social Security account online can keep you updated on the progress of your application and confirm approval prior to the letter being mailed out to you.”

There are three periods when you can sign up for Part B as well as Part A:

Your initial enrollment period, a seven-month window that begins three months before the month of your 65th birthday and lasts through the three months following the month of your 65th birthday. According to CMS, if your birthday is on the first of the month, the initial enrollment period starts, “four months before you turn 65 and ends two months after the month you turn 65.”
A special enrollment period if you have a qualifying life event.
A general enrollment period that runs from January 1 to March 31.

Part B coverage will start based on the month you sign up. If you sign up before the month you turn 65, coverage will begin the month you turn 65. However, if you sign up the month you turn 65 or during the three months after, coverage begins the next calendar month.

If your birthday is on the first of the month, then the period starts four months before you turn 65 and ends two months after the month you turn 65. For example, if your birthday is July 1 when you turn 65, your Initial Enrollment Period is March – September. If you sign up in March, April or May, your coverage starts June 1.

Medicare Part B special enrollment periods

Special enrollment periods are windows of time outside the normal enrollment period when you can sign up for Medicare health insurance.

Why would someone delay Part B coverage?

“With Part B, some people choose to defer this coverage if they already have health care coverage through their employer. Your special enrollment period is triggered on the date you leave that employer, and this period ends eight months after you lose your employer-issued health insurance. If you enroll for Part B within that eight-month window, you will not have to pay a Part B late enrollment penalty, which is equivalent to 10% of premiums for every 12 months someone waits to enroll when they should have enrolled,” Parker explains.

Note that if you’re not currently working and opt not to enroll in Part B but then decide to do so at a later time, you run the risk that your coverage could be delayed. Additionally, you may be forced to pay a higher monthly premium for as long as you have Part B.

Frequently Ask Questions

What is the difference between Medicare Part A and Part B?

Medicare Part A and Part B comprise Original Medicare.

Part A is hospital insurance, while Part B is medical insurance. While Part A is free to most Americans, Part B has a monthly premium that’s based on your household income. Medicare taxes help fund those programs.

Both Part A and Part B have annual deductibles. Health care providers and facilities that accept Medicare take both Parts A and B.

Do I have to apply for Medicare Part B?

Yes. You must opt into Medicare and enroll in Part B when you are eligible to do so. You can do this online through the Social Security website or by phoning 800-773-1213.

According to the Centers for Medicare and Medicaid website, “Individuals already receiving Social Security or RRB benefits at least 4 months before being eligible for Medicare and residing in the United States (except residents of Puerto Rico) are automatically enrolled in both premium-free Part A and Part B. People who are automatically enrolled have the choice whether they want to keep or refuse Part B coverage. People living in Puerto Rico who are eligible for automatic enrollment are only enrolled in premium-free Part A; they must actively enroll in Part B to get this coverage.”

Does Medicare Part B cover dental?

No, Medicare Part B doesn’t pay for most dental care services or devices, including regular cleanings, X-rays, tooth extractions, fillings, dentures, or dental plates.

“If you have dental services performed in a hospital, Medicare Part A will cover your inpatient hospital care in emergencies and during more complicated dental procedures,” says Reese.

Can I get Medicare Part B for free?

It’s possible to get Part B for free or at reduced costs. If you qualify for Medicaid, your premiums, deductibles, coinsurance, and copays may be paid for in full or partially.  The Medicare Savings Program is a federal/state program for people with low incomes can help pay premiums and copays. Eligibility varies by state, but people usually must have income limits. You can also get Medicare supplement insurance called Medigap that can help you pay out-of-pocket medical expenses. Although these plans are not free, Medigap could help off-set up-front medical costs. Note that deductibles and cost-sharing may still apply and these plans do have monthly premiums.

Or, if you are newly eligible for Medicare, or on Medicare and moving or losing coverage, you may be eligible for a Medicare Advantage plan from a private health insurance company, which may offer plans with $0 plan premiums.

How can I reinstate Medicare Part B?

If you canceled or disenrolled from your Part B coverage, you may be able to get reinstated. However, you might have to pay a late enrollment penalty to re-enroll unless you had group health insurance during the period when you did not have Part B.

“To re-enroll, you have to visit the Social Security office website, complete the application, and send the required documents to complete the process. If you left Part B coverage to enroll in an employer-issued plan, you may have to prove coverage in order to avoid paying late enrollment fees,” says Parker.

Is Medicare Part B automatically deducted from Social Security?

Yes, the Social Security Administration deducts the premium for your Part B monthly premium from your monthly Social Security check.

If you’re in Part B but not collecting Social Security, the Centers for Medicare and Medicaid Services will bill you quarterly for the Part B premium. You can pay the premium electronically by sending a check through the mail.

What is the income limit for Part B?

There’s no income limit to get Medicare Part B, but you pay higher premiums if your income is more than $97,000 or you file jointly and your combined income is more than $194,000.

Source:

Medicare.gov. “Costs.” Accessed November, 2023.

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Erik Martin

Contributing Researcher

Erik J. Martin is a Chicago area-based freelance writer whose articles have been published by AARP The Magazine, The Motley Fool, The Costco Connection, USAA, US Chamber of Commerce, Bankrate, The Chicago Tribune, and other publications. He often writes on topics related to insurance, real estate, personal finance, business, technology, health care, and entertainment. Erik also hosts a podcast and publishes several blogs, including Martinspiration.com and Cineversegroup.com.