Medicare Part B costs you a monthly premium, an annual deductible, and a percentage of most doctor visits and services
Medicare Part B is hospital insurance that covers doctor visits, outpatient care, lab tests, and medical equipment. You pay for it three ways: a monthly premium taken from your Social Security check, a yearly deductible you must meet before Medicare starts to pay, and coinsurance (usually 20 percent) on most services after you meet the deductible.
The exact amounts change each year. For 2024, the standard monthly premium is $164.90, the annual deductible is $240, and you typically pay 20 percent of the cost of covered services. However, your premium may be higher if your income was above a certain level two years ago — this is called Income-Related Monthly Adjustment Amount (IRMAA), and it can add $70 to $560 per month depending on your income bracket.
If you delay signing up for Part B when you first become may be able to access at 65, you will pay a permanent penalty of 10 percent more per year for each year you waited. That penalty stays on your premium for life, so understanding when to enroll matters.
Key Takeaways
- Part B costs a monthly premium (standard $164.90 in 2024), a yearly $240 deductible, and 20 percent coinsurance on most covered services.
- Your premium may be higher if your income was above $103,000 (single) or $206,000 (married) in 2022, due to income-related adjustments.
- Delaying Part B enrollment after age 65 adds a permanent 10 percent penalty to your monthly premium for each year you wait.
- Part B does not cover routine dental, vision, hearing aids, or long-term care, so you may need separate coverage for those services.
How the Monthly Premium Works
Your Part B premium is deducted automatically from your Social Security payment each month. If you are not yet receiving Social Security, Medicare bills you directly. The standard premium covers the basic cost of the program, but your actual premium depends on your income from two years prior.
If you earned more than $103,000 as a single filer or $206,000 as a married couple filing jointly in 2022, your 2024 premium will be higher. The brackets go up to $500,000 for single filers, and the premium can reach $560.50 per month for the highest earners. You will receive a notice in the mail if IRMAA applies to you, and you can appeal if your income dropped due to retirement, divorce, or death of a spouse.
The Annual Deductible and Coinsurance
Before Medicare Part B starts paying for your care, you must pay the annual deductible out of your own pocket. For 2024, that deductible is $240. Once you have paid $240 in covered services, Medicare pays its share (usually 80 percent) and you pay coinsurance of 20 percent on most services for the rest of the year.
This coinsurance applies to doctor office visits, lab work, imaging like X-rays and MRI scans, and durable medical equipment such as wheelchairs or oxygen. Some preventive services — like annual wellness visits, cancer screenings, and vaccines — have no coinsurance; Medicare covers them fully once you have met your deductible. However, if your doctor orders something that Medicare considers not medically necessary, you may owe the full cost.
What Part B Does Not Cover
Part B covers a lot, but it has clear gaps. It does not pay for routine dental care, eye exams for glasses or contacts, hearing aids, or most long-term care in a nursing home or at home. It also does not cover prescription drugs — that is Part D — or most vision and hearing services beyond a one-time eye exam after cataract surgery.
If you need these services, you can buy a separate Medigap policy (supplemental insurance) to cover some of the gaps, or you can choose a Medicare Advantage plan (Part C), which bundles Parts A, B, and D and may include dental and vision. Both options have their own costs and trade-offs.
Income-Related Adjustments (IRMAA) Explained
IRMAA is an extra charge added to your Part B premium if your income exceeds certain thresholds. Medicare looks back two years to calculate this, so your 2024 premium is based on your 2022 income. For 2024, the brackets are:
| Income (Single Filer) | Income (Married Filing Jointly) | Monthly Premium |
|---|---|---|
| $103,000 or less | $206,000 or less | $164.90 |
| $103,001–$129,000 | $206,001–$258,000 | $230.80 |
| $129,001–$161,000 | $258,001–$322,000 | $329.70 |
| $161,001–$193,000 | $322,001–$386,000 | $428.60 |
| Over $193,000 | Over $386,000 | $560.50 |
If your income drops due to retirement, you can request that Medicare recalculate your IRMAA using your current year income. You will need to file a form called the Medicare Income-Related Monthly Adjustment Amount — Life-Changing Event (form SSA-44) with Social Security within 60 days of the event.
The Late Enrollment Penalty
If you do not sign up for Part B when you first become may be able to access at 65, you will pay a penalty for as long as you have Medicare. The penalty is 10 percent of the standard premium for each full 12-month period you were may be able to access but did not enroll. If you waited three years, your premium would be 30 percent higher than the standard rate — and that extra amount never goes away.
The only exceptions are if you had other health coverage through an employer or spouse's employer, or if you are a federal employee covered under the Federal Employees Health Benefits Program. If either applies, you have a grace period to enroll without penalty. You will need to show proof of that coverage when you do sign up.
Ways to Lower Your Out-of-Pocket Costs
If Part B costs are stretching your budget, you may have options. Medicaid (the joint federal-state program for low-income people) can pay your Part B premium and deductible if you meet your state's income and asset limits. Each state sets its own limits, so contact your state Medicaid office to learn what you may have access to for.
A Medigap policy can cover your deductible and coinsurance, though you will pay a separate monthly premium for it. A Medicare Advantage plan typically has lower or no premiums but uses networks and may require prior authorization for some services. Some plans also offer dental, vision, and hearing coverage built in. Compare your options during the annual enrollment period (October 15 to December 7) to see what works for your situation.
Questions to Ask Your Doctor or Medicare
Before a procedure or test, ask your doctor whether Medicare Part B covers it and what your out-of-pocket cost will be. Ask whether the service is considered preventive (no coinsurance) or diagnostic (subject to the 20 percent coinsurance). If your doctor orders something you are unsure about, ask them to check with Medicare first — this is called advance beneficiary notice, and it protects you from surprise bills.
If you receive a bill you think is wrong, call Medicare at 1-800-MEDICARE (1-800-633-4227) and have your Medicare card and the bill in front of you. You can also check your claims online at MyMedicare.gov to see what Medicare paid and what you owe.
Frequently Asked Questions
Can I change my mind about Part B after I enroll?
Yes, during the annual enrollment period (October 15 to December 7) you can drop Part B or switch to a different plan. However, if you drop Part B and later want it back, you will owe the late enrollment penalty unless you have may have access to coverage through an employer.
What happens if I cannot afford my Part B premium?
Contact your state Medicaid office to see if you may have access to for help paying premiums. You can also ask Medicare about a payment plan if you fall behind. Do not ignore the bill — unpaid premiums can result in a gap in your coverage.
Does Part B cover telehealth visits?
Yes, Medicare Part B covers telehealth visits with your doctor, and you pay the same coinsurance (usually 20 percent) as you would for an in-person visit. The rules expanded during the pandemic and have largely stayed in place, though some restrictions explore depending on your location and the type of visit.
If I have Part B, do I still need Part D for prescriptions?
Yes. Part B covers doctor visits and services, but not prescription drugs. You need Part D (prescription drug coverage) or a Medicare Advantage plan that includes drug coverage. If you do not enroll in Part D when you first become may be able to access, you will pay a penalty if you sign up later.
What if my doctor charges more than Medicare allows?
If your doctor is a Medicare provider, they must accept Medicare's allowed amount as payment in full (except for your deductible and coinsurance). If they do not accept Medicare, you may owe the full bill. Always ask whether your doctor accepts Medicare assignment before scheduling.