Is Medicare Part B Worth the Monthly Premium? Here’s What You Get and What’s Missing

Key Takeaways

• Medicare Part B covers medically necessary services like doctor visits, outpatient care, preventive screenings, and durable medical equipment, which makes it an essential part of your overall Medicare coverage.

• While you pay a monthly premium for Part B, the coverage you receive can help reduce out-of-pocket expenses for routine and emergency medical care, but it does not cover everything.

What Medicare Part B Covers in 2025

Medicare Part B, known as Medical Insurance, is part of Original Medicare. In 2025, it continues to offer a wide range of benefits that help you manage your healthcare more affordably. Here’s what you get when you enroll in Part B:

Medically Necessary Services

These are services or supplies needed to diagnose or treat a medical condition. In 2025, Medicare Part B covers:

• Doctor visits (including specialists)

• Outpatient care

• Laboratory tests (blood work, urinalysis)

• Diagnostic imaging (X-rays, MRIs, CT scans)

• Mental health services (both outpatient and partial hospitalization)

• Durable medical equipment (DME) like walkers, wheelchairs, and oxygen equipment

Preventive Services

Medicare emphasizes preventive care, aiming to catch illnesses early or prevent them entirely. These services are typically covered in full when provided by a participating provider:

• Annual wellness visits

• Flu, pneumonia, hepatitis B, and COVID-19 vaccines

• Cancer screenings (mammograms, colonoscopies, prostate exams)

• Cardiovascular screenings

• Diabetes screenings and management training

What’s Not Included in Part B

Even though Part B covers a wide range of services, it doesn’t pay for everything. Understanding what’s excluded helps you avoid unexpected costs:

• Prescription drugs you take at home (covered separately by Part D)

• Long-term care, custodial care, or nursing home care

• Routine dental, vision, and hearing services

• Cosmetic surgery

• Care received outside the United States (with very limited exceptions)

These exclusions mean you may need additional coverage, such as a Medicare Part D plan for prescription drugs or supplemental coverage for dental and vision needs.

Understanding the 2025 Part B Costs

To receive these benefits, you pay a monthly premium. In 2025, the standard monthly premium for Medicare Part B is $185. This applies to most beneficiaries, though it can be higher if your income exceeds certain thresholds due to the Income-Related Monthly Adjustment Amount (IRMAA).

Other Part B Costs

In addition to the monthly premium, you are responsible for:

• Annual deductible: $257 in 2025. You must meet this before Medicare starts paying.

• Coinsurance: After the deductible, you typically pay 20% of the Medicare-approved amount for most services.

These amounts can add up, especially if you require frequent outpatient services, but having Part B means Medicare is covering the bulk of your costs.

How Part B Coordinates with Other Medicare Parts

Medicare Part B works alongside other parts of Medicare to give you broader coverage.

With Part A

Part A covers hospital inpatient care, while Part B covers outpatient care. Together, they form the core of Original Medicare.

With Part D

Since Part B doesn’t cover most prescription drugs, you may choose to enroll in Part D for drug coverage. This helps you pay for medications you take at home.

With Medigap (Medicare Supplement Insurance)

Medigap policies can help cover the coinsurance, copayments, and deductibles that Part B doesn’t pay. Many people with Original Medicare enroll in Medigap for this reason.

Who Should Consider Enrolling in Part B?

You’re eligible for Part B if you’re 65 or older, or younger with certain disabilities. Enrollment is optional, but if you don’t sign up when you’re first eligible and don’t qualify for a Special Enrollment Period, you may face a late enrollment penalty.

People Who Shouldn’t Delay Enrollment

• Those not covered by employer group health plans

• Retirees who no longer have employer-sponsored health coverage

• Individuals with frequent medical visits or ongoing outpatient treatments

People Who Might Delay

• Those still working with employer coverage

• Individuals with coverage through a spouse’s employer

If you delay enrollment and later lose your coverage, you’ll have a Special Enrollment Period to sign up without penalty, usually within 8 months.

Enrollment Timeline and Process

Medicare Part B enrollment follows a clear timeline. You should understand these windows to avoid penalties and gaps in coverage.

Initial Enrollment Period (IEP)

• Starts 3 months before your 65th birthday

• Ends 3 months after the month you turn 65

• Total of 7 months

General Enrollment Period (GEP)

• Runs from January 1 to March 31 each year

• Coverage begins July 1

• May involve late enrollment penalties

Special Enrollment Period (SEP)

• If you lose employer coverage or other qualifying coverage

• Lasts for 8 months from the time you lose coverage

Is It Worth the Monthly Premium?

Many people ask whether paying a monthly premium for Part B is worth it. Here’s a breakdown of what you gain in exchange for that monthly cost:

Pros

• Access to necessary medical services: You’re covered for outpatient services and preventive care.

• Lower out-of-pocket costs: Without Part B, paying out-of-pocket for outpatient services can be financially overwhelming.

• Coordination with other coverage: Part B integrates well with Part A, Part D, and supplemental plans.

• Peace of mind: Knowing you have access to care when needed provides confidence and security.

Cons

• Monthly premium and cost-sharing: Even with Medicare, you’re still responsible for part of the cost.

• Doesn’t cover everything: You’ll need separate coverage for dental, vision, hearing, and prescription drugs.

• Penalties for late enrollment: Delaying Part B can lead to permanent penalties unless you qualify for an exception.

What Happens If You Skip Part B?

Some people choose not to enroll in Part B, especially if they have other coverage. However, skipping it without qualifying coverage can have long-term consequences:

• Late Enrollment Penalty: Your premium increases by 10% for each 12-month period you were eligible but not enrolled.

• Delayed Coverage: If you miss your IEP and don’t qualify for SEP, you must wait for the GEP, with coverage starting months later.

• Out-of-Pocket Exposure: Without Part B, you pay the full cost for outpatient services, which can be financially risky.

Special Considerations for 2025

In 2025, the Medicare landscape continues to evolve, especially with the cost changes introduced in the current year:

• The Part B premium increased to $185 from $174.70 in 2024.

• The annual deductible rose to $257 from $240 in 2024.

These increases reflect rising healthcare costs but also come with expanded access to preventive services and more flexible mental health coverage.

The Bottom Line: Coverage Now vs. Costs Later

When deciding whether to enroll in Medicare Part B, you’re weighing the ongoing cost of premiums and cost-sharing against the financial risk of not having coverage.

For most people, the protection Part B offers against major outpatient medical costs justifies the monthly premium. If you rely on doctor visits, tests, or mental health services, skipping Part B could result in significant out-of-pocket expenses.

Choosing Smartly Means Planning Ahead

As you evaluate whether Medicare Part B is right for you, make sure you consider your current health needs, your other sources of coverage, and your long-term financial goals. Don’t wait until a medical issue arises to realize you’re underinsured. Speak with a licensed agent listed on this website to explore your best options and ensure you’re making an informed decision.