What Is Medicare Part B? Know What’s Included and What’s Not

Navigating Medicare can feel like a maze, but understanding each part is the first step to feeling confident about your coverage. Medicare Part B is one of the main building blocks of Original Medicare, and it helps cover the care you receive outside of a hospital. Think doctor’s visits, preventive screenings, outpatient treatments, and medical equipment, things that help you stay well and get back on your feet when life throws a curveball.

While Medicare Part A covers inpatient hospital stays, Part B picks up where Part A leaves off. But it’s not always easy to know exactly what’s included and what isn’t, and that’s where many people run into surprises.

In this guide, we’ll walk you through who qualifies for Part B, how enrollment works, what it covers, what it doesn’t, how much it costs, and how Unified Health can help you make the best choice for your health and your budget.

Who Is Eligible for Medicare Part B?

You’re eligible for Medicare Part B if you’re 65 or older, or if you’re under 65 with certain disabilities or health conditions like ALS or End-Stage Renal Disease (ESRD). You also need to be a U.S. citizen or a lawful permanent resident who has lived in the U.S. for at least five continuous years.

Eligibility alone, however, doesn’t always mean you’ll be automatically enrolled. If you’re already receiving Social Security or Railroad Retirement Board benefits before age 65, you’ll typically be enrolled automatically in both Part A and Part B. But if you’re not yet receiving those benefits, you’ll need to sign up yourself, and timing matters.

Enrolling on time ensures access to benefits and helps avoid penalties or delays in coverage. Even if you’re healthy and not currently seeing a doctor regularly, Part B coverage can be critical for preventive services and future health needs.

How and When to Enroll in Part B

Timing your enrollment correctly is crucial to avoid penalties and coverage delays. Here are the main enrollment periods:

• Initial Enrollment Period (IEP): Starts 3 months before the month you turn 65 and ends 3 months after (7 months total). This is the best time to enroll.

• General Enrollment Period (GEP): January 1 – March 31 each year. If you miss your IEP, you can enroll during the GEP, but coverage starts July 1, and penalties may apply.

• Special Enrollment Period (SEP): Triggered by specific events, like losing employer-sponsored insurance, allowing you to sign up without penalty.

Already getting Social Security benefits before age 65? You’ll be auto-enrolled in Part A and B. If not, you must apply manually.

What Does Medicare Part B Cover?

Medicare Part B is designed to support outpatient medical needs. Coverage is based on medical necessity, and services must be provided by Medicare-approved providers. Here are some of the most commonly covered services:

• Doctor Visits and Outpatient Services: Whether you're seeing a primary care physician or a specialist, Part B helps cover the cost of office visits, diagnostic tests, and outpatient procedures.

• Preventive Services: Screenings, vaccines, and yearly wellness visits are fully covered to catch health issues early and keep you feeling your best.

• Durable Medical Equipment (DME): If your doctor prescribes it, Part B can help cover equipment like wheelchairs, walkers, oxygen tanks, and CPAP machines.

• Mental Health Services: Therapy, screenings, and outpatient behavioral health services are included under Part B, supporting both your physical and emotional wellness.

• Certain Outpatient Medications: While most prescriptions fall under Part D, medications given during outpatient care (like chemotherapy or infusions) are covered under Part B.

What Part B Does Not Cover

Equally important is understanding where Part B coverage ends. It does not cover:

• Inpatient hospital stays – These fall under Part A.

• Most prescription drugs taken at home – These are covered under Part D.

• Routine dental, vision, and hearing care – Exams, eyeglasses, and hearing aids are not included under Part B.

• Long-term custodial care – Assistance with daily living activities, like bathing or dressing, is not covered unless it’s part of short-term skilled care.

Knowing these gaps allows you to consider supplemental options, like Medigap or Medicare Advantage plans, to fill in the blanks and provide more comprehensive coverage.

What Does Medicare Part B Cost?

Part B isn’t free; there are several costs to be aware of:

• Monthly Premium: Standard in 2025 is $174.70. High-income earners may pay more (based on IRMAA).

• Annual Deductible: $240 in 2025. You must meet this before coverage begins.

• Coinsurance: After you meet your deductible, Medicare pays 80%, and you typically pay 20% of approved service costs.

For example:

• Doctor visit: $150 → You pay about $30

• Medical equipment (like a walker): $200 → You pay around $40

If you're on a limited income, Medicare Savings Programs may help cover premiums and other costs. Unified Health can check your eligibility and help you apply.

Preventing Coverage Gaps and Late Penalties

One of the most common mistakes we see is missing the right time to enroll in Medicare Part B. If you don’t have other creditable coverage and you delay enrollment, you could be hit with a penalty that increases your premium by 10% for each full 12-month period you wait.

But that penalty doesn’t go away. It’s added to your monthly premium for as long as you have Part B.

To avoid this, enroll during your Initial Enrollment Period or be sure you have coverage from another source, like an employer or union plan, that qualifies as creditable. If you’re not sure, Unified Health can help you figure it out.

How to Sign Up for Part B

There are multiple ways to enroll:

• Online: Visit SSA.gov and follow the steps to apply.

• By Phone or Mail: Contact your local Social Security office.

• With Help: A licensed Medicare agent or advisor can walk you through the process.

Before enrolling, have your personal details ready, Social Security number, work history, and any current insurance info.

At Unified Health, our licensed agents offer free support to help you compare your options, avoid costly mistakes, and feel confident in your coverage choices.

What If Your Needs Change? (Special Cases)

Your Medicare coverage can change as your life does. If you move, retire, or lose employer coverage, it’s important to review your options. Switching to a Medicare Advantage plan (Part C) means your Part B benefits are included in a bundled plan that may also offer dental, vision, and drug coverage. If you're dual-eligible for Medicare and Medicaid, you may qualify for additional help with premiums and out-of-pocket costs. Whenever your circumstances shift, Unified Health is here to guide you through the next step and help you find coverage that fits your evolving needs.

Common Myths and Misunderstandings

There’s a lot of confusion around Medicare. Let’s clear some of it up:

• “Part B covers all prescription drugs.” False, most home-use prescriptions require a Part D plan.

• “You don’t need Part B if you’re healthy.” Even healthy people benefit from preventive services and unexpected needs.

• “Enrollment is automatic for everyone.” Not true if you’re not collecting Social Security; you need to manually enroll.

Having the facts can save you time, money, and stress.

Recap and Next Steps

Medicare Part B plays a vital role in your healthcare coverage, especially when it comes to outpatient care, preventive services, and medically necessary treatments.

To recap:

• Part B is essential for managing your health outside of hospital stays.

• Enroll on time to avoid costly late penalties.

• Know the gaps in coverage to explore supplemental options.

• Costs vary, but financial help is available.

Ready to make sense of your Medicare options? Unified Health is here to help. Our team of licensed agents can answer your questions, compare your plan choices, and guide you through the enrollment process at no cost to you.

Contact Unified Health today to take the first step toward confident coverage.

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