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Medicare Part B is designed to cover outpatient, physician, and preventive services that aren’t covered by Medicare Part A. Medicare Part B has a monthly premium, so people who continue to work after becoming eligible for Medicare often choose to delay their enrollment in Medicare Part B until after their job-sponsored insurance ends.
Medicare Part B covers a broad range of medically necessary and preventive services that aren’t picked up by inpatient coverage – even though they might be received while a person is hospitalized. This includes physician visits, ambulance services, certain surgical procedures, dialysis, mental health care, physical therapy, transplants, chemotherapy and radiation, urgent care, and more.
In addition, Medicare Part B covers diagnostic tests (such as MRIs, CT scans, EKGs, and x-rays) and a host of preventive medical services, such as pap tests, HIV screening, glaucoma tests, hearing tests, diabetes screening, and colorectal cancer screenings. Medicare Part B also pays the costs of durable medical equipment such as wheelchairs, hospital beds, and oxygen equipment, and for drugs that are taken by infusion (most drugs are covered under Medicare Part D, but drugs administered via infusion are covered under Part B instead).
For 2024, the Medicare Part B premium is $174.70/month for most enrollees. (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:
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.
Medicare Part B enrollees with income above $103,000 (single) / $206,000 (married) pay higher premiums than the rest of the Medicare population in 2024. (This threshold was $85,000/$170,000 prior to 2020, but it was adjusted for inflation starting in 2020.) The 2024 Medicare Part B premiums for high-income beneficiaries range from $244.60/month to $594/month.
This income-related monthly adjustment amount (IRMAA) is based on your income tax return from two years ago. That’s the most recent tax return they have on file at the start of the plan year (when the 2024 plan year begins, the most recent tax returns on file are for 2022, so 2022 income is used to determine IRMAAs for 2024). But if a life-change event has reduced your income since then, there’s an appeals process available. You can use it to request that the income-related premium adjustment be changed or eliminated without having to wait for it to reflect on a future tax return.
Enrollees who receive treatment during the year that’s covered by Medicare Part B must also pay a deductible, which increased to $240 for 2024 (up from $226 in 2023; 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.
[hio_question question="Does everyone have to pay the Medicare Part B deductible?"]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 the 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:
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.
If you have health insurance through your current employer, or through your spouse’s current employer, you may want to delay enrollment in Medicare Part B, if your employer has 20 or more employees. You’ll need to check with your employer or HR department to make sure that your employer-sponsored coverage will pick up where Medicare Part A leaves off, but assuming it does, you may want to delay enrolling in Medicare Part B, since it has a premium.
As long as you enroll in Medicare Part B either while you (or your spouse, if your coverage is through your spouse’s employer) are still employed and you have health coverage from that employer — or within eight months of the end of employment or the termination of the health plan — you’ll be able to enroll without any penalty. This is regardless of what time of year it is, and regardless of how long ago you turned 65.
If your employment ends, you may be eligible to continue your employer-sponsored coverage via COBRA. However, coverage under COBRA does not have the same protections as far as access to Medicare Part B and the ability to enroll without a penalty.
Once your employment ends, you’ve got eight months to sign up for Medicare Part B (regardless of what time of year it is, and without a penalty). You can have COBRA coverage during those eight months if you wish. But once it’s been more than eight months since your employment ended, you no longer have open access to Medicare Part B other than during the General Enrollment Period, even if you’re still covered under COBRA.
Once it’s been more than eight months since your employment ended, the details above about late enrollment in Medicare Part B apply. You’ll only be able to sign up between January 1 and March 31, and late enrollment penalties can be applied to your premium.
This is something to keep in mind if you elect COBRA once your employment ends. If your COBRA runs out in the middle of the year (and you haven’t yet enrolled in Medicare Part B) you won’t have access to Medicare Part B at that point. You’ll have to wait until the following January – March General Enrollment Period, and depending on how long it’s been since your employment ended, you could also face a late-enrollment penalty that will apply to your Medicare Part B premium for the rest of your life.
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. 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):
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):
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.