There are two different payment questions: who pays your Part B premium, and who pays a bill for medical care. The premium keeps coverage active; it is not the amount you owe for every visit.
Paying the monthly premium
Most beneficiaries have the Part B premium deducted from Social Security or Railroad Retirement Board benefits. People without those deductions generally receive a premium bill. An income-related adjustment or late-enrollment penalty can change the amount due.
| Possible help | What to confirm |
|---|---|
| Medicare Savings Program | State eligibility category and premium-payment start date. |
| Employer or retiree benefit | Written reimbursement rules and required proof. |
| Medicare Advantage premium reduction | Whether the specific plan offers it and the actual amount. |
None of these should be assumed merely because a person is over 65 or has a plan advertised with a zero monthly premium.
Paying for care
Under Original Medicare, Part B generally pays 80% of the approved amount for covered services after the deductible; exceptions apply, including many qualifying preventive services. You may owe the remaining cost unless another benefit helps. A provider's full billed charge and Medicare's approved amount are not always the same.
Other insurance can change payment order. Active employment, employer size and the reason for Medicare eligibility matter. Medicaid generally coordinates after Medicare for Medicare-covered care. Medicare Advantage uses its own covered-service cost sharing within applicable rules.
A practical billing checklist
- Confirm the current premium and payment method.
- Keep state or employer assistance approval letters.
- Check who pays first before the provider files a claim.
- Compare medical bills with Medicare or plan notices.
- Ask for correction if the wrong insurance or effective date was used.
If the premium is unaffordable, request a state assistance screening. Do not stop paying without understanding the effect on your coverage.
Related coverage questions
- Medicare Part B: Medical Coverage, Costs and Enrollment
- IRMAA 2026: Medicare Part B Income Brackets and Review Options
- QMB Medicare Savings Program: Help With Costs and Billing Protection