Medicare Part B – enrollee benefits and coverage costs

For 2025, the Medicare Part B premium is $185/month for most enrollees.¹ (See below for an overview of how Medicare Part B premiums have changed over the years.)

Medicare Part B premiums can be covered by Medicaid if the beneficiary is eligible for both programs. And high-income enrollees pay more than the standard premiums for Medicare Part B.

Some enrollees can get Medicare Part B for free. There are essentially three ways this is possible, and although they aren’t applicable to most Medicare beneficiaries, it’s useful to know what options are available for covering the cost of the premiums. Here are the scenarios:

• Your income and assets are low enough to qualify for full Medicaid or a Medicare Savings Program that covers the cost of Medicare Part B. Medicare Savings Programs are run by each state’s Medicaid office, and eligibility varies from one state to another.
• You or your spouse are continuing to work and the employer offers a QSEHRA or an ICHRA that reimburses your Medicare Part B premiums.
• You enroll in a Medicare Advantage plan that has a “giveback” rebate that covers the entire Medicare Part B premium. Giveback rebates are not the norm, but do tend to be available in most areas (for 2024, nearly one out of five Medicare Advantage plans included at least some amount of giveback rebates). However, the rebate amount can vary from as little as 10 cents per month to as much as the full premium. So it’s important to understand that many enrollees who get a giveback rebate do still have to pay something for Part B.

Part B premiums for most enrollees are deducted from their Social Security checks. But there’s a “hold harmless” rule that prevents net Social Security checks from declining from one year to the next, unless the person has an income high enough to be subject to the income-related surcharges for Medicare Parts B and D.

So if the Medicare Part B premium increases by more than an enrollee’s Social Security cost of living adjustment (COLA), the person’s premium will be adjusted, and will end up being less than the standard amount.

Due to fairly small COLAs, most beneficiaries paid less than the standard amount for Medicare Part B in 2017 (an average of $109/month, versus the standard premium of $134/month) and 2018 (an average of $130/month, versus the standard premium that remained at $134/month). By 2019, CMS estimated that only about 3.5% of Medicare beneficiaries were still paying a lower-than-standard amount for Part B, as COLAs had caught up with standard Part B premium increases by that point. By 2020, virtually all non-high-income Part B enrollees were paying the standard premium for Part B.

For 2025, the standard Part B premium increased by a little more than $10/month.¹ The Social Security COLA for 2025 is 2.5%, which amounts to an average increase of about $49/month.² The dollar amount of the COLA is larger for those who receive larger checks, and smaller for those who receive smaller checks. But the hold harmless provision would only be applicable in a case where a 2.5% increase amounted to less than about $10 and thus wasn’t enough to cover the increase in the standard Part B premium.

Enrollees who receive treatment during the year that’s covered by Medicare Part B must also pay a deductible, which increased to $257 for 2025¹ (up from $240 in 2024; see below for an overview of how the Medicare Part B deductible has changed over time). After the deductible, enrollees also pay 20% of the Medicare-approved amount for care that’s covered under Medicare Part B, although supplemental coverage from a Medigap plan, Medicaid, or an employer-sponsored plan can be used to cover some or all of the Medicare Part B out-of-pocket costs.

Learn how Medicare premiums, deductibles and coinsurance changed for 2024.

No, not everyone pays the Medicare Part B deductible. People who don’t receive services under Medicare Part B (or who only receive deductible-free preventive services, such as vaccines), do not have to pay the deductible. And although most Medicare beneficiaries do receive services that are covered under Medicare Part B, some of them do not have to pay the Part B deductible:

• Medigap plans C and F cover the deductible, so if you still have one of those plans, you’re not responsible for paying the Medicare Part B deductible. (This is why those plans are no longer available to people who become newly eligible for Medicare after the end of 2019, under the terms of the Medicare Access and CHIP Reauthorization Act. The idea is that there will be less unnecessary utilization of health care if all Original Medicare enrollees are subject to the Part B deductible, but critics argue that it could also hinder access to necessary care.)
• Enrollees who have Medicaid, employer-sponsored health coverage, or retiree health benefits from an employer generally don’t have to pay the full Medicare Part B deductible, as the other coverage picks up some or all of the cost (this varies depending on the plan).
• Some Medicare Advantage plans have no deductibles and low copays. Medicare Advantage enrollees pay the Medicare Part B premium plus the Medicare Advantage premium (the majority of Medicare Advantage plans have no premium other than the cost of Medicare Part B), and then the Medicare Advantage insurer wraps the Medicare Parts A and B (and in most cases, Medicare Part D) benefits into one plan for the enrollee, with cost-sharing that can differ greatly from the standard Original Medicare cost-sharing.

According to a Kaiser Family Foundation analysis, about 8% of Medicare beneficiaries only have Medicare Parts A and B, without supplemental coverage (other than Medicare Part D, which covers prescription drugs rather than services covered by Original Medicare). They don’t have Medigap coverage, employer-sponsored coverage, retiree health benefits from a former employer, or Medicaid. These enrollees — along with beneficiaries who have a Medigap plan other than C or F — have to pay the full Part B deductible if and when they need services that are covered under Medicare Part B.

If you are already receiving Social Security or Railroad Retirement benefits, you will be notified three months prior to your 65th birthday that you are about to be enrolled in Medicare Part A, and that Medicare Part B is an option. You’ll receive the Medicare Part B card at the same time as the Medicare Part A card.

If you choose not to enroll in Medicare Part B, you must return the card (which means you’re rejecting Medicare Part B coverage; more on that below) or the premium will automatically start to be deducted from your Social Security checks. If you keep the card, Medicare Part B coverage kicks in the month you turn 65.

If you’re not already receiving Social Security or Railroad Retirement benefits, you’ll have an opportunity to enroll in Medicare B (along with Medicare Part A) during a seven-month window that includes the three months before the month you turn 65, the month you turn 65, and the following three months.  If you enroll in the three months prior to the month you turn 65, your coverage will be effective the month you turn 65.

It’s important to note that if you fail to enroll in Medicare Part B during your seven-month enrollment period, the program will offer you another opportunity to enroll each succeeding year (January 1 – March 31), with coverage effective the month after you enroll (the effective date used to be July 1, but this changed as of 2023, under the BENES Act). The catch? If and when you do eventually enroll in Medicare Part B, for each year that you were eligible for Part B but turned it down, your monthly premium will be increased by 10%, and the higher rate will be in place for as long as you have Medicare Part B.

So if you wait three full years to enroll after your initial enrollment period, you’ll pay premiums that are 30% higher than the normal price, for as long as you have Medicare Part B coverage (generally, for life). The penalty does not apply, however, if you delay your Part B enrollment because you have other coverage in place from a current employer or your spouse’s current employer.

Medicare Part B is optional. You can choose to skip it altogether and avoid the premiums. But that means you’re on the hook for the full cost of any services that would otherwise be covered under Medicare Part B. For healthy enrollees, that might amount to the occasional office visit and nothing more. But if you end up needing extensive outpatient care — such as kidney dialysis, chemotherapy, radiation, physical therapy, etc. — your bills could add up quickly.

As noted above in the discussion about late enrollments, you will have a chance to sign up for Medicare Part B each year, regardless of how long you’ve delayed enrollment. But the late-enrollment penalty could become substantial, depending on how long you’ve waited to enroll. And if and when you do decide to enroll, you’ll have to wait until the January-March General Enrollment Period. So going without Medicare Part B when you don’t have other coverage from a current employer’s plan is an option, but it’s a fairly risky option.

The standard Medicare Part B premium has generally increased over time, although there have been some years when it stayed the same or even decreased. Here’s a historical summary of standard Medicare Part B premiums (not applicable to those subject to the “hold harmless” rule or IRMAA) over the last several years (see Table V.E2):

• 2005: $78.20
• 2006: $88.50
• 2007: $93.50
• 2008: $96.40
• 2009: $96.40
• 2010: $110.50
• 2011: $115.40
• 2012: $99.90 (decrease)
• 2013: $104.90
• 2014: $104.90
• 2015: $104.90
• 2016: $121.80
• 2017: $134.00
• 2018: $134.00
• 2019: $135.50
• 2020: $144.60
• 2021: $148.50
• 2022: $170.10
• 2023: $164.90 (decrease)
• 2024: $174.70
• 2025: $185

The Medicare Part B deductible has generally increased over time, although there have been some years when it stayed the same or even decreased. The increase for 2022 was the largest year-over-year dollar increase in the program’s history. But the decrease for 2023 was the first time the deductible had declined in over a decade. Here’s a historical summary of Medicare Part B deductibles over the last several years (see Table V.E2):

• 2005: $110
• 2006: $124
• 2007: $131
• 2008: $135
• 2009: $135
• 2010: $155
• 2011: $162
• 2012: $140 (decrease)
• 2013: $147
• 2014: $147
• 2015: $147
• 2016: $166
• 2017: $183
• 2018: $183
• 2019: $185
• 2020: $198
• 2021: $203
• 2022: $233
• 2023: $226 (decrease)
• 2024: $240
• 2025: $257