What Part B Covers in 2025—and Why That Still Might Not Be Enough

Key Takeaways

• Medicare Part B offers essential coverage in 2025 for outpatient services, doctor visits, preventive care, and medical equipment—but it comes with significant gaps that could lead to unexpected expenses.

• Understanding the limitations of Part B is crucial for planning your healthcare budget in retirement, especially with rising costs and no cap on out-of-pocket spending.

What Medicare Part B Offers in 2025

Medicare Part B is a critical component of your Medicare coverage. It helps you pay for services and supplies needed for diagnosing or treating medical conditions outside of a hospital setting. In 2025, Part B continues to cover a broad range of medically necessary services, including:

Physician Services

You’re covered for doctor visits, including:

• Primary care consultations

• Specialist appointments (with or without referral, depending on plan structure)

• Telehealth visits (when medically appropriate)

Outpatient Care

Part B covers medically necessary outpatient care such as:

• Emergency department visits (when not admitted)

• Observation stays

• Same-day surgeries at outpatient facilities

Preventive Services

To help detect health problems early, Part B covers many preventive screenings at no additional cost to you, including:

• Annual wellness visits

• Screenings for cancer (e.g., mammograms, colorectal screenings)

• Cardiovascular disease screenings

• Diabetes screenings

Durable Medical Equipment (DME)

You’re also covered for equipment that your doctor prescribes for home use, including:

• Wheelchairs

• Hospital beds

• Blood sugar monitors

Mental Health Services

Mental health care is included under Part B for both outpatient and partial hospitalization services:

• Psychotherapy (individual and group)

• Psychiatric evaluation and medication management

• Substance use disorder treatment in outpatient settings

Lab Tests and Diagnostic Imaging

You’re covered for medically necessary lab work and imaging:

• Blood tests, urinalysis

• MRIs, CT scans, and X-rays

Ambulance Services

Part B covers ground ambulance transport to a hospital or skilled nursing facility if other transportation could endanger your health.

The Costs You’re Responsible for in 2025

Although Part B pays for many vital services, it does not provide full coverage. Understanding your financial responsibilities helps you avoid surprises.

Premiums

The standard monthly premium for Medicare Part B in 2025 is $185. Higher-income beneficiaries pay more based on Income-Related Monthly Adjustment Amounts (IRMAA).

Deductibles

You’ll pay an annual deductible of $257 before Part B begins covering your care.

Coinsurance

After you meet your deductible, Medicare typically covers 80% of the approved amount. You are responsible for the remaining 20%, and there’s no limit on how high this amount can go in a year.

For example:

• A $10,000 outpatient procedure could leave you paying $2,000 out-of-pocket.

This 20% coinsurance applies to:

• Doctor visits

• Diagnostic tests

• Physical therapy

• DME

What Part B Does Not Cover

Medicare Part B is not all-inclusive. Many people assume it covers everything outside the hospital—but there are several essential services it does not cover.

Prescription Drugs

Routine outpatient prescription drugs are not covered under Part B. You need separate Part D coverage for most medications filled at a pharmacy. However, Part B does cover certain medications administered in a clinical setting (e.g., chemotherapy).

Long-Term Care

Custodial care (such as help with bathing, dressing, or eating) in a nursing home or at home is not covered unless skilled nursing or rehabilitation is required and conditions are met under Part A.

Vision, Dental, and Hearing

In 2025, Part B still does not include routine services such as:

• Eye exams or glasses

• Dental cleanings, fillings, or dentures

• Hearing aids and exams for fitting

Routine Foot Care

Unless it’s medically necessary due to a condition like diabetes, regular foot exams and treatment are not covered.

Why Gaps in Part B Matter More Than Ever in 2025

Healthcare costs are steadily rising. With no cap on your annual out-of-pocket expenses under Part B, a single illness or accident could lead to thousands in unexpected bills. The following realities amplify the impact in 2025:

Inflation and Healthcare Pricing

Medical inflation continues to outpace general inflation, which means:

• You could face higher provider charges

• Equipment and therapy services may cost more

Higher Utilization

As more people age into Medicare, demand for outpatient services increases. This strain on the system can mean longer wait times or reduced provider availability—and more visits that count toward your 20% share.

Chronic Conditions and Aging

Many older adults have multiple chronic conditions, such as hypertension, diabetes, or arthritis. Managing these requires ongoing doctor visits, tests, and therapies—all adding up under Part B’s 20% coinsurance structure.

Coordinating Part B With Other Coverage

To protect yourself from unpredictable costs, it’s important to know how Part B interacts with other forms of coverage.

Part B and Part D

Since Part B does not cover retail prescriptions, many people enroll in Part D for drug coverage. But even Part D comes with its own deductible and out-of-pocket limits, so it’s still important to budget.

Part B and Medicare Supplement (Medigap)

Medigap policies are designed to help pay some or all of the remaining 20% coinsurance that Part B does not cover. These are standardized plans, and enrollment is typically best within six months of turning 65 or starting Part B to avoid underwriting.

Part B and Employer Coverage

If you’re still working and covered under a group health plan, Medicare Part B may be secondary. In that case, you may choose to delay Part B enrollment without penalty—as long as the employer coverage is considered creditable.

Part B and Medicaid

Those with limited income and resources might qualify for Medicaid, which can help cover premiums, deductibles, and coinsurance. Programs like QMB (Qualified Medicare Beneficiary) offer significant help, but require meeting income and asset limits.

Timing and Enrollment in 2025

Understanding when to enroll in Part B matters just as much as understanding what it covers.

Initial Enrollment Period (IEP)

This 7-month window begins 3 months before the month you turn 65, includes your birthday month, and ends 3 months after. Enroll during this period to avoid lifelong late penalties.

General Enrollment Period (GEP)

If you miss your IEP and don’t qualify for a Special Enrollment Period, you can enroll from January 1 to March 31 each year. Coverage begins the following month. You may owe a penalty for each 12-month period you delayed enrollment.

Special Enrollment Period (SEP)

If you or your spouse are still working and have employer coverage, you can delay enrolling in Part B. After that coverage ends, you have 8 months to enroll penalty-free.

Smart Steps to Prepare for 2025 and Beyond

Planning for your medical needs isn’t just about understanding what Part B offers—it’s about preparing for what it doesn’t.

Here are steps you can take:

• Budget for out-of-pocket costs – Factor in deductibles, coinsurance, and services not covered.

• Explore supplemental coverage – Research standardized Medigap policies or other options that may reduce your share of costs.

• Use preventive care – Since many preventive services are covered in full, take advantage of them to avoid bigger costs later.

• Review your providers – Make sure they accept Medicare assignment to limit what you owe.

• Know enrollment timelines – Delaying Part B can lead to penalties unless you qualify for an exception.

Planning Around Part B’s Gaps Is Just as Important as Knowing What It Covers

While Medicare Part B provides essential outpatient benefits in 2025, it doesn’t eliminate all your healthcare expenses. It’s critical to prepare for what Part B leaves out—from routine dental and vision to prescription drugs and catastrophic costs.

If you’re unsure about the best way to coordinate your coverage or want to explore supplemental options, get in touch with a licensed agent listed on this website. They can help you find coverage that fits your health needs and budget.