Medicare Part B

Medicare Part B is medical insurance, genuinely distinct from Part A. It helps cover the care you receive specifically as an outpatient, plus a defined set of preventive services.

What Part B Covers

• Doctor visits and outpatient care
• Preventive services like screenings and annual wellness visits
• Durable medical equipment (wheelchairs, walkers, etc.)
• Ambulance services and some outpatient mental health care

Part B’s standard monthly premium is currently $202.90, along with an annual deductible of $283 and typically 20% coinsurance for most covered services after that. A Medicare Supplement plan can help cover that 20%, which is why it’s worth comparing your options rather than assuming Original Medicare alone is enough.

The 20% Adds Up More Than People Expect

Part B’s 20% coinsurance genuinely has no annual cap under Original Medicare alone — there’s simply no built-in stopping point where Medicare starts covering 100% of your outpatient costs for the remainder of the year, no matter how much you’ve already paid. For routine visits, that 20% is usually manageable. If you need an expensive outpatient procedure, ongoing specialist care, or extended physical therapy, that uncapped 20% can add up to a real number. That open-ended exposure is the single biggest reason we recommend most clients pair Part B with either a Medicare Supplement plan or a Medicare Advantage plan rather than relying on Original Medicare by itself.

Higher Premiums for Higher Incomes

Most people genuinely pay the standard Part B premium, but if your household income is above certain thresholds, you may pay meaningfully more through what’s officially called an Income-Related Monthly Adjustment Amount, or IRMAA for short. This is based specifically on your tax return from two years prior, so a genuinely one-time high-income year (like a large retirement account withdrawal or the sale of a home or rental property) can temporarily bump your monthly premium higher than your ongoing income would otherwise suggest. If that happens to you, there’s an appeals process for certain qualifying life changes — we can point you toward it if this applies to your situation.

Here’s the current IRMAA table for both Part B and Part D, based on your 2024 tax return:

What Counts as “Preventive”

Part B covers a specific, clearly defined list of preventive services — an annual wellness visit, many cancer screenings, cardiovascular screenings, flu and certain other vaccines, and quite a bit more besides — usually at absolutely no cost to you as long as you meet the specific eligibility criteria for each individual service. It’s worth knowing this list exists rather than assuming a checkup that turns into a diagnostic visit stays “free” — once a preventive visit uncovers something requiring diagnosis or treatment, that portion of the visit is typically billed as a regular Part B service.

Enrolling in Part B: Timing Matters More Than People Expect

Unlike Part A, Part B carries a genuine late enrollment penalty if you don’t sign up when you’re first eligible and don’t have qualifying employer coverage — and that penalty isn’t temporary. It’s added to your monthly premium for as long as you have Part B, calculated based on how many full 12-month periods you went without coverage after becoming eligible. Your Initial Enrollment Period runs the same seven months as Part A’s — three months before your 65th birthday month, your birthday month, and three months after — and missing that window without qualifying employer coverage generally means waiting for the General Enrollment Period each year from January through March, with coverage not starting until July. That gap in coverage, on top of the penalty, is exactly why enrollment timing deserves real attention rather than being an afterthought.

What Qualifies as Employer Coverage for Delaying Part B

The rules here trip people up regularly: coverage through an employer with 20 or more employees generally lets you delay Part B penalty-free until that coverage ends, but coverage through a smaller employer, COBRA, or retiree health benefits typically doesn’t carry the same protection — Medicare often expects you to enroll in Part B at 65 regardless in those situations. Getting this wrong can mean months or years of unexpected late enrollment penalties discovered only when you finally do enroll. We check the specific size and type of your employer coverage before you make any assumption about whether delaying Part B is safe for your situation.

A Real Scenario Involving IRMAA

A client sold a rental property the year before enrolling in Medicare, generating a one-time capital gain that pushed her reported income well above her normal range. Two years later, that single high-income year triggered an IRMAA surcharge on her Part B premium, even though her actual ongoing income had returned to its normal level by then. Because the sale was a one-time event rather than an ongoing income change, she qualified to file an appeal using a specific life-change form, and her premium was recalculated using more current income information. Not everyone in this situation qualifies for an appeal — it depends on the specific reason for the income spike — but it’s always worth asking rather than assuming a two-year-old tax return is the final word on your current premium.

Part B and Outpatient Mental Health Care

Part B covers outpatient mental health services, including visits with a psychiatrist, psychologist, or clinical social worker, subject to the same deductible and 20% coinsurance structure as other Part B services. Coverage for annual depression screenings is provided at no cost when performed in a primary care setting equipped to provide follow-up treatment. This is an area of Medicare that’s expanded meaningfully in recent years, and it’s worth asking about specifically if mental health care is part of your ongoing needs, since coverage details here can be easy to overlook amid the more commonly discussed hospital and prescription benefits.

Durable Medical Equipment in More Detail

Part B covers durable medical equipment — items like wheelchairs, walkers, hospital beds, and oxygen equipment — when a doctor certifies they’re medically necessary for use in your home. Coverage typically requires the equipment to be prescribed by your doctor and supplied through a Medicare-enrolled equipment supplier, and the standard Part B deductible and 20% coinsurance apply the same way they would to any other covered service. A detail worth knowing: some equipment is covered as a rental rather than a purchase, particularly for higher-cost items, which affects your ongoing cost-sharing differently than a one-time purchase would. We’re glad to walk through the specific process for any equipment you’re anticipating needing.

Part B Ambulance Coverage

Part B covers ambulance transportation when other transportation would genuinely endanger your health and the ambulance is going to or from an appropriate medical facility, subject to the standard deductible and 20% coinsurance. Non-emergency ambulance transportation can also be covered in certain situations, such as transport between facilities for a service not available at your current location, but it generally requires that the transport be medically necessary and, in some cases, pre-authorized. This is an area where costs can add up unexpectedly if it isn’t handled correctly, so it’s worth understanding the requirements before you need this kind of transport, not during an emergency itself.

Common Questions

Can I delay Part B without a penalty?

Yes, genuinely, if you have qualifying coverage through an employer (generally one with 20 or more employees) at the point you turn 65. Once that specific employer coverage genuinely ends, you’ll typically get a Special Enrollment Period to sign up for Part B without facing any late penalty at all. Smaller employers, retiree coverage, and COBRA don’t always qualify the same way, so it’s genuinely worth confirming your specific situation with us before you decide.

Does Part B cover prescription drugs?

Only certain drugs administered in a clinical setting, like some infusions or injections given during a doctor’s visit. Regular prescription medications you pick up at a pharmacy are covered under Part D, not Part B.

What happens if I miss my Part B enrollment window entirely?

Without qualifying employer coverage, you’d generally need to wait for the General Enrollment Period each January through March, with coverage starting that July, and you’d likely face a late enrollment penalty added permanently to your premium. This is exactly the kind of situation worth catching before it happens rather than after.

Does Part B cover telehealth visits?

Yes, for a range of services, subject to the same deductible and coinsurance structure as an in-person visit. Telehealth coverage rules have expanded and shifted several times in recent years, so it’s worth confirming current details for a specific service you’re considering rather than assuming based on older information.

If you want genuine help thinking through how much of that 20% coinsurance you’d realistically be exposed to in a typical year, bring your usual doctor visit pattern and any upcoming procedures to a conversation with us — we’re based in Bethel and serve Cincinnati, Hamilton, Clermont, Butler, and Warren County directly, at no cost and with no pressure to enroll in anything on the spot.