What does Medicare B pay for for seniors?

Asked by: Domingo Marks  |  Last update: October 4, 2025
Score: 4.3/5 (52 votes)

Medicare Part B covers physicians' services, outpatient hospital services, certain home health services, durable medical equipment, and certain other medical and health services not covered by Medicare Part A.

What does Medicare Part B actually pay for?

Part B covers things like:

Durable medical equipment (DME) Limited outpatient prescription drugs. Mental health & substance use disorders. Oxygen equipment & accessories.

Does everyone pay $170 for Medicare Part B?

Most people pay no premiums for Part A. For Medicare Part B in 2025, most beneficiaries will pay $185 per month. Certain factors may require you to pay more or less than the standard Medicare Part B premium in 2025.

What is not covered by Medicare Part B?

Medicare Part B does not pay for some services that fall under the coverage of other parts. Examples include inpatient hospital services, which Part A funds, and most prescription medications, which Part D funds. Medicare regularly evaluates which services Part B will cover.

Does Medicare Part B cover 100%?

With Medicare Part B, you pay 20 percent of the cost for the services you use. So if your doctor charges $100 for a visit, then you are responsible for paying $20 and Part B pays $80. There is no limit on Part B coinsurance costs, which could add up if you have a lot of doctor visits or need other services.

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Why is Social Security no longer paying Medicare Part B?

There could be several reasons why Social Security stopped withholding your Medicare Part B premium. One common reason is that your income has exceeded the threshold for premium assistance. Another reason could be that there was a mistake or error in your records.

What are the 6 things Medicare doesn't cover?

Some of the items and services Medicare doesn't cover include:
  • Eye exams (for prescription eyeglasses)
  • Long-term care.
  • Cosmetic surgery.
  • Massage therapy.
  • Routine physical exams.
  • Hearing aids and exams for fitting them.

Who is exempt from paying Medicare Part B premiums?

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).

What blood tests does Medicare not cover for seniors?

It's important to know that Medicare won't cover any blood test if it isn't medically necessary. If you seek a blood test on your own, it's unlikely you'll get it covered. Tests not covered may include those for employment purposes, wellness screenings, or routine monitoring without medical necessity.

Does Medicare Part B cover an ambulance?

Medicare Part B covers emergency ambulance services and, in limited cases, non-emergency ambulance services. Medicare considers an emergency to be any situation when your health is in serious danger and you cannot be transported safely by other means.

How do I avoid paying Medicare Part B?

You may refuse Part B without penalty if you have creditable coverage, but you have to do it before your coverage start date. Follow the directions on the back of your Medicare card if you want to refuse Part B.

What are the top 5 medicare supplement plans?

💬 From our Nerds: What are the top five Medicare supplement plans? "Based on NerdWallet's Medigap rubric, I picked five best Medicare Supplement Insurance companies for 2025: AARP/UnitedHealthcare, Mutual of Omaha, State Farm, Anthem and Blue Cross Blue Shield.

What are the changes coming to social security in 2025?

Social Security's earnings test limits also rose in 2025. This year, seniors who work and collect benefits will be able to earn more money without risking having a portion of their Social Security withheld.

Why do seniors pay for Medicare Part B?

Part B is optional. Part B helps pay for covered medical services and items when they are medically necessary. Part B also covers some preventive services like exams, lab tests, and screening shots to help prevent, find, or manage a medical problem. Cost: If you have Part B, you pay a Part B premium each month.

What is the 80/20 rule in Medicare?

The 80/20 Rule generally requires insurance companies to spend at least 80% of the money they take in from premiums on health care costs and quality improvement activities. The other 20% can go to administrative, overhead, and marketing costs. The 80/20 rule is sometimes known as Medical Loss Ratio, or MLR.

Do I need both A and B Medicare?

No. If you aren't eligible for free Part A, you don't have to enroll. However, if you want to buy Medicare coverage and you want Part A, you also have to buy Part B.

What surgeries are not covered by insurance?

Cosmetic procedures such as plastic surgery or vein removal are nearly always considered elective and so are not covered. Fertility treatments are only covered in certain states, and even then, there are loopholes that allow insurers to deny coverage.

Is Medicare Part B based on your income?

If we determine you're a higher-income beneficiary, you'll pay a larger percentage of the total cost of Part B based on the income you normally report to the Internal Revenue Service (IRS). You'll pay monthly Part B premiums equal to 35%, 50%, 65%, 80%, or 85% of the total cost, depending on what you report to the IRS.

Which is not covered by Medicare Part B?

Generally, most vision, dental and hearing services are not covered by Medicare Parts A and B. Other services not covered by Medicare Parts A and B include: Routine physical exams. Cosmetic surgery.

Does Medicare cover dental?

In most cases, Medicare doesn't cover dental services like routine cleanings, fillings, tooth extractions, or items like dentures.

Why are people leaving Medicare Advantage plans?

Key takeaways: People leave Medicare Advantage plans because out-of-pocket costs vary between plans, network restrictions can cause frustration, prior authorization requests can delay care, and it can be difficult to use the additional benefits they provide.

What is the best supplemental insurance for Medicare?

The best Medicare supplement plan providers
  • Best for extra plan benefits: Humana.
  • Best for straightforward coverage: State Farm.
  • Best for extensive medical care coverage: AARP by UnitedHealthcare.
  • Best for a range of Medigap plans: Blue Cross Blue Shield.

What are 3 services not covered by Medicare?

We don't cover these routine items and services: Routine or annual physical checkups (visit Medicare Wellness Visits to learn about exceptions). exams required by third parties, like insurance companies, businesses, or government agencies. Eye exams for prescribing, fitting, or changing eyeglasses.