Key Takeaways
-
In 2025, Medicare Part B covers a wide range of medically necessary and preventive services, but you are still responsible for monthly premiums, deductibles, and coinsurance.
-
Certain services, like most dental, hearing aids, and long-term care, are not covered under Part B, so you may need to explore other coverage options or pay out of pocket.
What Medicare Part B Covers in 2025
Medicare Part B is your gateway to outpatient medical services and preventive care. In 2025, it continues to serve as an essential part of Original Medicare, offering coverage for doctor visits, diagnostic tests, and more. But not everything is covered, and there are still costs you need to plan for.
Medically Necessary Services
Medically necessary services are those needed to diagnose or treat a medical condition. Medicare Part B covers a large variety of these services, including:
-
Doctor and specialist visits
-
Outpatient surgeries and procedures
-
Diagnostic tests (e.g., blood tests, X-rays, MRIs)
-
Durable medical equipment (DME) such as walkers, oxygen tanks, and wheelchairs
-
Ambulance transportation (when other transport could endanger your health)
-
Mental health services (both outpatient and partial hospitalization)
-
Chemotherapy and radiation for cancer treatment
Preventive Services
Preventive care is a core part of Medicare Part B. In 2025, you can expect coverage for:
-
Annual wellness visit
-
Screenings for cancer (mammograms, colonoscopies, prostate cancer screenings)
-
Cardiovascular disease screenings
-
Diabetes screenings and self-management training
-
Flu shots, COVID-19 vaccines, and other immunizations
-
Depression screening and counseling
These services are generally covered without cost to you, as long as your provider accepts Medicare assignment.
What You Have to Pay For
Even with Medicare Part B, you are still responsible for certain costs in 2025. Understanding these expenses helps you better prepare and avoid surprises.
Monthly Premiums
The standard monthly premium for Medicare Part B in 2025 is $185. However, if your income is above a certain threshold, you may pay more due to the Income-Related Monthly Adjustment Amount (IRMAA).
Annual Deductible
You must meet the annual deductible before Medicare Part B starts to pay its share. In 2025, the deductible is $257. This means you pay the first $257 of covered services yourself before cost-sharing begins.
Coinsurance
After you meet your deductible, you typically pay 20% of the Medicare-approved amount for:
-
Doctor visits
-
Lab tests
-
Durable medical equipment
-
Outpatient services
This 20% coinsurance has no annual cap under Original Medicare, so costs can add up quickly if you receive frequent care or need expensive treatments.
Services Not Covered by Part B
Despite its comprehensive range, Medicare Part B does not cover everything. In 2025, the following services remain outside the scope of Part B:
-
Most dental care, including routine cleanings, fillings, and dentures
-
Vision care related to eyeglasses or contact lenses (unless post-cataract surgery)
-
Hearing aids and routine hearing exams
-
Long-term care or custodial care (e.g., assisted living, nursing home stays not tied to medical treatment)
-
Prescription drugs (covered separately under Part D or other plans)
For these services, you either pay out of pocket or explore supplemental insurance to help cover the gaps.
Special Coverage Situations
Some situations may lead to additional coverage under Medicare Part B, depending on medical necessity and doctor recommendations.
Home Health Services
If you’re homebound and under a doctor’s care, Medicare Part B may cover:
-
Part-time skilled nursing care
-
Physical, occupational, or speech-language therapy
-
Medical social services
-
Home health aide (part-time, if skilled care is also needed)
Second Opinions for Surgery
You’re entitled to a second (and even a third) opinion before undergoing non-emergency surgery. Medicare Part B pays for these visits if the surgery is medically necessary.
Clinical Research
You may qualify for clinical research studies under Medicare Part B if the research is Medicare-approved. You’ll typically pay 20% of the Medicare-approved amount unless you have additional coverage.
What Providers You Can See
In 2025, Medicare Part B lets you see any provider in the U.S. who accepts Medicare. However, not all providers accept Medicare assignment, which means:
-
Providers who accept assignment agree to the Medicare-approved amount as full payment.
-
Providers who don’t accept assignment can charge up to 15% more than the Medicare-approved amount (a practice known as balance billing).
You’re responsible for this extra amount unless you have supplemental coverage that pays it.
When Coverage Begins
If you enroll during your Initial Enrollment Period (IEP), your Part B coverage starts based on the month you sign up:
-
If you enroll the month you turn 65, coverage begins the following month.
-
If you sign up during one of the three months after your 65th birthday, coverage starts one to three months after enrollment.
If you miss your IEP, you may sign up during the General Enrollment Period (January 1 to March 31), but coverage won’t begin until July 1, and you may face a late enrollment penalty.
Late Enrollment Penalty
If you delay enrolling in Medicare Part B without qualifying for a Special Enrollment Period, you may face a permanent penalty. The penalty is calculated as 10% of the standard premium for each 12-month period you delayed enrollment. This penalty is added to your monthly premium every year you have Part B.
To avoid this, ensure you enroll on time—especially if you’re not covered by employer-based insurance.
Coordination with Other Coverage
If you have additional coverage—like through an employer, retiree plan, or union—you’ll need to understand how Medicare Part B coordinates with it.
-
If Medicare is primary, it pays first. Your other insurance pays second.
-
If Medicare is secondary, the other coverage pays first, and Medicare may cover the remaining eligible costs.
Knowing the order matters because if Medicare is supposed to be primary and you didn’t enroll, you could be stuck with the full bill.
Appealing a Denied Claim
In some cases, Medicare may deny payment for a service you believe should be covered. In 2025, you can file an appeal in five stages:
-
Request a redetermination from the Medicare Administrative Contractor (MAC).
-
Request reconsideration by a Qualified Independent Contractor (QIC).
-
Request a hearing before an administrative law judge.
-
Ask for Medicare Appeals Council review.
-
File a case in federal court.
Each stage has its own timeline, and you must act promptly. Keep detailed records and gather supporting documents when appealing.
Staying Informed in 2025
Medicare continues to evolve each year. In 2025, staying up to date on changes—such as updates to coverage, cost-sharing amounts, and provider policies—is essential to making the most of your Part B benefits. The Annual Notice of Change (ANOC) and Medicare & You handbook are valuable resources for keeping track of what’s new.
Make the Most of Your Medicare Part B Coverage
Medicare Part B in 2025 gives you access to essential outpatient and preventive services, but it’s not a catch-all solution. You’ll still be responsible for premiums, deductibles, coinsurance, and any non-covered services.
To make smart coverage decisions and avoid unexpected costs, it helps to talk to someone who knows the ins and outs of Medicare. Reach out to a licensed agent listed on this website for personalized advice tailored to your healthcare needs.
