Understanding Medicare Part B

Part B (Medical Insurance) covers:

• Physician’s services received as an inpatient and outpatient
• Emergency hospital care
• Ambulance services
• Medical equipment
• Medical supplies
• Home health care (if not Part A)
• Other health services such as lab fees, test, etc.

Monthly Premium

Part B comes with a monthly premium. In 2025 it is $185.00. Everyone pays this amount. The premium is deducted from the monthly Social Security benefit if the individual receives that benefit. For individuals that do not receive a Social Security benefit, bills are issued for premiums every three months (or monthly if requested).

Annual Deductible

A beneficiary is responsible for an initial set amount of approved charges each year before Medicare Part B payments will be considered. The amount is called the annual deductible and may change for each calendar year. ($257.00 for 2025)

Services not covered by Medicare and charges in excess of the Medicare approved amount do not count toward the deductible.

Coinsurance (80/20 percentages)

Medicare Part B pays 80% of the approved amount in most instances. The beneficiary is responsible for the remaining 20% of the Part B approved charges for covered services (after the deductible is met).

Copayments

For certain outpatient procedures, Medicare Part B pays a set amount. That’s called a copayment. The beneficiary is responsible for a fixed dollar amount set by the healthcare facility.

Part B pays only for services determined to be reasonable and necessary in the diagnosis and treatment of a specific illness or injury.

For example, Part B does not pay for excessive visits to a doctor or for services not generally accepted by the medical community as reasonable and necessary.

However, a specific set of preventive services are paid under Part B:

• Abdominal aortic aneurysm screening Hepatitis B shots
• Alcohol misuse screening and counseling Hepatitis B Virus (HBV) infection
• Breast cancer screening (mammograms) Hepatitis C screening test
• Cardiovascular disease behavioral therapy HIV Screening
• Cervical and vaginal cancer screenings Lung cancer screening
• Depression screening Medical nutrition therapy services
• Diabetes Prevention Program Obesity screening and counseling
• Flu Shots Prostate cancer screening
• Covid Shots Sexually transmitted infection screening
• Glaucoma test Smoking and tobacco cessation