Medicare Part B: What It Covers, What It Costs
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Medicare Part B covers outpatient care like doctor’s office visits, preventive care, scans and tests.
Most people pay a premium of $164.90 per month in 2023.
It’s important to sign up when you become eligible for Medicare to avoid late enrollment penalties.
If you sign up for Medicare Advantage, your plan covers your Part B services.
Medicare Part B covers outpatient care like doctor’s office visits, preventive care, scans and tests.
Most people pay a premium of $164.90 per month in 2023.
It’s important to sign up when you become eligible for Medicare to avoid late enrollment penalties.
If you sign up for Medicare Advantage, your plan covers your Part B services.
Medicare Part B is the portion of Medicare that covers most doctor visits and other outpatient medical services. It also covers durable medical equipment and preventive services.
Most people pay a premium of $164.90 per month in 2023. You might pay more if your income exceeds certain thresholds.
Here’s what you should know about Medicare Part B.
What does Medicare Part B cover?
Medicare Part B generally covers care and services delivered at clinics or other outpatient locations. It's part of Original Medicare, along with Part A, which generally covers care at hospitals and some skilled nursing facilities.
Medicare Part B coverage
Medicare Part B covers two kinds of services: medically necessary outpatient care and preventive services.
Medically necessary outpatient care
Medicare Part B covers a variety of outpatient care and services when they’re medically necessary. According to the Centers for Medicare & Medicaid Services, medically necessary services are “services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.”
After you’ve paid your Medicare Part B deductible for the year, Part B generally pays for 80% of covered medically necessary services. You’re responsible for a 20% Part B coinsurance for most covered services.
Here are some examples of medically necessary services covered by Medicare Part B:
Outpatient services like visits to a health care provider at an office or clinic and services such as X-rays, stitches and casts that you get at a hospital without being admitted as an inpatient.
Durable medical equipment like CPAP machines, lift chair mechanisms, wheelchairs, canes, walkers, diabetes supplies and hospital beds, if they’re medically necessary and prescribed by your doctor.
Ambulance services to the nearest appropriate medical facility to get medically necessary care, if traveling in any other vehicle could endanger your health.
Prescription drugs you don’t give yourself, like infusions or injections you have to get at a doctor’s office or hospital outpatient department. (Most prescription drugs, which you take yourself, are covered by Medicare Part D or Medicare Advantage plans that include prescription drug coverage instead.)
Mental health services like therapy or counseling, psychiatric evaluations, medication management and partial hospitalization for mental health issues. (Part A covers mental health care if you’re admitted as an inpatient.)
Medicare preventive services
Medicare Part B also covers preventive care and services, including certain disease and cancer screenings, tests, shots and counseling.
While most medically necessary services require a 20% Part B coinsurance, you don’t pay anything for most preventive services.
Here are a few examples of preventive services for which you’ll pay nothing under Medicare Part B:
Screening colonoscopies (you may need to pay coinsurance for additional services like polyp removal or barium enemas).
Certain preventive services are limited to certain sexes and/or have conditions on how often Medicare covers them. To pay nothing for some services, you need to get them from a health care provider that accepts Medicare assignment. You can find specific details for how individual services are covered at medicare.gov/coverage.
What Part B doesn’t cover
There are a number of services Medicare Part B doesn’t cover. You’d be responsible for paying for these services out of pocket unless you have other insurance that covers them.
Here are a few examples of services not covered by Medicare Part B:
Most dental care and dentures.
Routine eye exams (unless you're at risk for certain conditions).
Care while traveling abroad (except under rare circumstances).
Cosmetic surgery.
Medicare Part B eligibility
You become eligible for Medicare Part B at age 65 and should sign up for Medicare during the initial enrollment period, the seven-month period around your birthday. People can also become eligible for Medicare based on disability before age 65.
Medicare Part B late enrollment penalty
It’s extremely important to sign up for Medicare Part B on time. If you decide not to sign up for Part B at age 65 when you become eligible and later change your mind, you’ll pay an extra 10% above the standard premium cost for every 12-month period you delayed. What’s more, you’ll pay this late enrollment penalty for the entire time you're covered by Medicare. That extra premium can add up to a significant amount over the course of your retirement.
Medicare Part B cost
Medicare Part B has premiums, a deductible and coinsurance:
You need to pay the premiums each month, regardless of what care or services you get.
You need to pay your deductible out of pocket before Part B will start paying for most covered services.
You pay a 20% coinsurance for most medically necessary services covered by Part B, but there’s no coinsurance for most preventive care.
Part B premiums
Most people pay the standard Medicare Part B monthly premium: $164.90 per month in 2023. (Premium amounts usually change from year to year.)
Part B premiums with Medicare Advantage
Many people who sign up for Medicare choose a Medicare Advantage plan, also known as Medicare Part C. Medicare Advantage plans are sold by private insurance companies, and they must have at least the same coverage as Original Medicare (Part A and Part B). Often these policies include Medicare Part D prescription drug coverage and extra benefits not covered by Original Medicare, which may include some coverage for dental, vision, wellness and some home-care benefits.
You’re still responsible for your Medicare Part B premium even if you choose a Medicare Advantage plan. However, some Medicare Advantage plans will pay for some or all of your Part B premiums.
To see whether a plan will pay for some or all of your Part B premium, look for Medicare Advantage plans with “Part B premium reduction” or “Giveback” benefits.
Medicare Part B premiums for members with high income
High-income beneficiaries may pay higher premiums for Medicare Part B. If your modified adjusted gross income from two years ago is above a certain threshold, you also need to pay an income-related monthly adjustment amount, or IRMAA.
For 2023, beneficiaries whose 2021 income exceeded $97,000 (individual return) or $194,000 (joint return) will pay a premium amount ranging from $230.80 to $560.50, depending on income.
Medicare Part B deductibles and coinsurance
Medicare Part B comes with an annual deductible: $226 in 2023.
After you meet the deductible for the year, you typically pay 20% of the Medicare-approved amount for doctor services and other Medicare benefits. Medicare Part B pays the other 80%.
Your costs are limited to that 20% coinsurance if your doctor or other provider accepts Medicare assignment. In other words, your provider will accept the amount Medicare agrees to pay for the treatment or service. Some providers who charge more than the Medicare-assigned amount may bill patients for the difference. Always check with a new physician or other health care provider that they accept the amount Medicare pays.
Many Original Medicare enrollees purchase Medicare Supplement Insurance, also called Medigap, to help pay the out-of-pocket costs associated with Medicare Part B.
The parts of Medicare
Read more about the different parts of Medicare and what they cover.
