Why Medicare Part B Is the One You Can’t Afford to Skip

Key Takeaways

• Medicare Part B covers essential outpatient medical services that most people need, including doctor visits, lab tests, and preventive care. Skipping it could leave you responsible for substantial healthcare bills.

• Delaying Part B without qualifying coverage from a current employer can lead to lifelong late enrollment penalties and significant gaps in medical coverage.

What Medicare Part B Covers Right Now

Medicare Part B plays a crucial role in your overall Medicare coverage by handling most of your outpatient needs. In 2025, it covers:

• Physician services (both primary care and specialists)

• Preventive screenings (e.g., mammograms, colonoscopies)

• Durable medical equipment (such as walkers or home oxygen)

• Lab tests and diagnostic services

• Outpatient mental health services

• Ambulance services (when medically necessary)

• Certain medications administered in outpatient settings (e.g., infusions, injections)

This broad range of services forms the core of most people’s regular healthcare use. Without Part B, you would be on your own to pay for many of these expenses.

Who Needs to Enroll—and When

Most people become eligible for Medicare at age 65. You are automatically enrolled in Part B if you’re already receiving Social Security benefits at that time. If you aren’t, you must sign up manually.

Your Initial Enrollment Period (IEP) is your first opportunity to enroll. It lasts 7 months:

• Starts: 3 months before your 65th birthday month

• Includes: your birthday month

• Ends: 3 months after your birthday month

If you miss this window and don’t have other qualifying health coverage from an active employer, you may be locked out until the General Enrollment Period (January 1 to March 31 each year), and coverage wouldn’t begin until July 1.

The Cost of Skipping Part B Is Steeper Than You Think

Skipping Part B may seem like a way to save money in the short term, but it often backfires financially. Here’s why:

You May Owe a Penalty for Life

If you delay enrollment without other qualifying coverage (such as employer-sponsored insurance from active work), you’ll face a late enrollment penalty. As of 2025, the penalty is calculated as follows:

• For each 12-month period you delay, your premium goes up by 10%

• This increase is permanent for the lifetime of your Part B coverage

So, if you wait two years, you’ll pay 20% more every month—forever.

You Might Go Without Coverage When You Need It Most

Medical issues can arise unexpectedly, and without Part B, you could face large bills. Even common situations like a fall, a check-up after a sudden illness, or diagnostic tests would not be covered.

Part B also complements Part A. If you’re hospitalized (covered by Part A), follow-up care, outpatient procedures, or even same-day discharges typically fall under Part B. Delaying it disrupts the balance of care and coverage.

Exceptions: When It May Be Okay to Delay

There are situations where you can safely delay Part B without penalties:

• You or your spouse have creditable coverage through an employer-sponsored plan from active employment (not retiree coverage)

• You’re still working and covered by that plan when you turn 65

In such cases, you can enroll in Part B later during a Special Enrollment Period (SEP) without a penalty. The SEP:

• Starts when your employment or coverage ends (whichever comes first)

• Lasts for 8 months

Keep in mind: COBRA, retiree coverage, and VA benefits do not count as creditable coverage for Part B purposes.

How Part B Coordinates with Other Coverage

If you do have other insurance, knowing how Part B works with it is critical:

• If you’re 65+ and have employer coverage from an employer with 20+ employees, the employer plan typically pays first and Medicare pays second.

• If the employer has fewer than 20 employees, Medicare becomes primary. In this case, delaying Part B could leave you with unpaid medical bills because your employer plan may only cover what Medicare doesn’t.

If you’re a federal retiree or a Postal Service annuitant, coordination between Part B and your federal health plan (now PSHB in 2025) often lowers your out-of-pocket costs. Many PSHB plans waive deductibles or lower copays if you have both Part B and your plan.

Common Myths About Medicare Part B

“I Don’t Go to the Doctor Often, So I Don’t Need It”

While you may be healthy now, health needs can change quickly with age. If you’re not enrolled and face a sudden issue, you might end up paying entirely out-of-pocket.

“I Thought Medicare Was Free”

Only Part A is typically premium-free if you’ve worked and paid taxes for at least 10 years. Part B always comes with a monthly premium. For 2025, that standard premium is $185, though it can be higher based on income.

“I’ll Just Enroll Later If I Need It”

If you don’t have employer-based coverage, you could be forced to wait months to enroll—and then pay a higher premium permanently. That delay can mean serious financial risk.

Income Can Affect Your Monthly Premium

Most people pay the standard Part B premium, but if your income is above a certain threshold, you may pay more. This adjustment is called IRMAA (Income-Related Monthly Adjustment Amount). In 2025:

• The threshold begins at $106,000 for individuals

• It begins at $212,000 for couples filing jointly

Your premium is based on your income from two years prior, so your 2025 rate uses your 2023 tax return.

If your income has gone down due to life changes like retirement, you can request a reassessment.

What If You Missed Enrollment? There Are Still Options

If you didn’t sign up during your IEP and don’t qualify for a Special Enrollment Period, you can still enroll during the General Enrollment Period (GEP):

• Dates: January 1 – March 31

• Coverage begins: The first day of the month after enrollment

Note: This is a change from before 2023, when coverage didn’t begin until July. Now, the delay is shorter, but penalties may still apply.

Choosing to Delay Part B Could Affect Prescription Drug Access

While Medicare Part D covers most prescriptions, some medications are administered in clinical settings—such as chemotherapy, injected arthritis medications, or IV infusions. These fall under Part B.

Without Part B, you might not have access to those critical treatments unless you’re willing and able to pay the full cost out of pocket.

Planning for Medicare Requires Looking Ahead

Enrolling in Medicare isn’t just about your 65th birthday. It’s about:

• Knowing your deadlines

• Evaluating your current coverage

• Estimating future healthcare needs

• Budgeting for premiums and possible IRMAA charges

Part B is the gateway to receiving most medical services under Medicare. Skipping or delaying it without proper planning can leave you financially vulnerable and medically underprotected.

Medicare Part B Is a Core Investment in Your Health

Medicare Part B ensures you can access outpatient care, preventive services, and critical medical support when you need it most. Delaying enrollment may look like a cost-saving measure, but in reality, it often results in higher expenses and more limited care.

Don’t assume that skipping Part B is a safe option—because for most people, it isn’t. If you’re unsure whether or not you should enroll, timing matters.

To make the best decision for your situation, get in touch with a licensed agent listed on this website who can walk you through your options.​​​​​​​