Key Takeaways
- Medicare Part B covers outpatient services, including doctor visits, lab work, and preventive screenings.
- The standard 2026 Medicare Part B monthly premium is $202.90, with an annual deductible of $283.
- After meeting the deductible, Part B covers 80% of approved costs; you pay the remaining 20% coinsurance.
- Original Medicare (Part A and Part B) does not have an annual out-of-pocket maximum.
- Enrolling on time is crucial to avoid permanent late enrollment penalties.
Understanding Medicare Part B: Your Key to Outpatient Medical Care
Most people know Medicare covers hospital stays. However, the part of Medicare used almost every week for doctor appointments, lab work, imaging, and preventive screenings is an entirely separate piece called Medicare Part B.
Without Part B, routine outpatient care comes with a significant price tag. Medicare Part B is the medical insurance component of Original Medicare, covering medically necessary outpatient services and preventive care.
It works alongside Part A (hospital insurance) to form the foundation of federal health coverage for Americans 65 and older, as well as certain younger individuals with qualifying disabilities or conditions.
Part A vs. Part B
Part A handles what happens when you're admitted to a hospital or skilled nursing facility. Part B handles what happens everywhere else, including primary care visits, specialist appointments, X-rays, chemotherapy, and physical therapy.
Understanding Part B means understanding its core financial components: the monthly premium, the annual deductible, and the 20% coinsurance. Each of these directly affects what you'll spend out of pocket throughout the year.
Key Takeaways
The standard 2026 Medicare Part B monthly premium is $202.90, with an annual deductible of $283 before coverage applies. After meeting your deductible, Part B pays 80% of approved costs, and you pay the remaining 20% with no annual out-of-pocket cap. Enrolling on time is critical, as missing your Initial Enrollment Period without qualifying coverage can trigger a permanent late enrollment penalty.
Key Facts About Medicare Part B in 2026
For 2026, the standard monthly Part B premium is $202.90, an increase from $185 in 2025. This premium is typically deducted automatically from your Social Security benefit each month.
The annual Part B deductible for 2026 is $283, an increase from $257 in 2025. You pay 100% of Medicare-approved costs for covered services until you reach this amount.
2026 Part B Costs at a Glance
Standard Monthly Premium: $202.90. Annual Deductible: $283. Coinsurance: 20% after deductible.
Once the deductible is met, Medicare generally covers 80% of the approved cost for most Part B services. You are responsible for the remaining 20% as coinsurance.
No Out-of-Pocket Maximum
Because there is no annual out-of-pocket maximum under Original Medicare, this 20% coinsurance can accumulate significantly during a serious illness or extended treatment.
Enrollment timing matters enormously. Your primary window to sign up is the Initial Enrollment Period, which spans seven months centered around your 65th birthday.
Missing it without qualifying for a Special Enrollment Period can result in permanent cost penalties.
What Medicare Part B Covers: Essential Medical Services
Part B coverage falls into two broad categories: medically necessary services and preventive services. Medically necessary services are those your doctor determines are required to diagnose or treat a medical condition.
Preventive services are designed to catch problems early or keep you healthy before issues arise.
Doctor office visits with primary care physicians and specialists
Outpatient surgery and surgical procedures performed in ambulatory settings
Diagnostic lab tests, blood work, and urinalysis
Imaging services such as X-rays, MRIs, and CT scans
Chemotherapy and radiation therapy for cancer treatment
Mental health services, including outpatient counseling and psychiatric care
Ambulance transportation when medically necessary
Physical therapy, occupational therapy, and speech-language pathology
Preventive Care at No Cost
Preventive services are typically covered at no additional cost to you, meaning no deductible or coinsurance, when provided by a provider who accepts Medicare assignment. Key examples include the Annual Wellness Visit, cardiovascular screenings, diabetes screenings, mammograms, and colonoscopies.
Part B also covers durable medical equipment (DME) such as wheelchairs, walkers, hospital beds for home use, and oxygen equipment, when prescribed by your doctor and deemed medically necessary. The 20% coinsurance applies to DME after your deductible is met.
Part B Coverage for Telehealth Services
Telehealth coverage under Part B has expanded significantly in recent years and is now a permanent feature. You can receive a wide range of medical consultations, mental health services, and follow-up care from the comfort of your home using video or phone technology.
Telehealth Benefits
Telehealth is particularly valuable for beneficiaries with limited mobility or those living in rural areas where specialist access can be challenging. Services like therapy sessions, medication management, and chronic care check-ins are all available.
Standard Part B cost-sharing applies to most telehealth visits, meaning your deductible and 20% coinsurance still come into play, just as they would for an in-person appointment.
Understanding Part B Costs: Premiums, Deductibles, and Coinsurance
The $202.90 standard monthly premium is deducted from your Social Security payment in most cases. If you're not yet collecting Social Security, you'll receive a quarterly bill from Medicare instead.
The $283 annual deductible resets every January 1. Until you've paid $283 out of pocket for Part B-covered services during the calendar year, you bear the full approved cost of those services yourself.
Once the deductible is met, Medicare picks up 80% of approved charges for most services. The 20% coinsurance, what you pay after the deductible, carries no ceiling under Original Medicare alone.
High Coinsurance Risk
A single course of outpatient chemotherapy or a prolonged specialist treatment plan can generate thousands of dollars in coinsurance. This is a central reason many beneficiaries explore supplemental coverage options.
Understanding Medicare assignment is also important. When a provider "accepts assignment," they agree to bill Medicare directly and accept the Medicare-approved amount as full payment. Your cost is limited to your deductible and 20% coinsurance.
Providers who don't accept assignment can charge more, up to 15% above the approved amount.
Income-Related Monthly Adjustment Amount (IRMAA)
Higher-income beneficiaries pay more for Part B through a surcharge called IRMAA, the Income-Related Monthly Adjustment Amount. It's calculated based on your Modified Adjusted Gross Income (MAGI) from two years prior.
This means your 2024 income determines your 2026 IRMAA, if applicable. The income thresholds that trigger IRMAA in 2026 are as follows:
| Individual Income (2024) | Joint Income (2024) | Monthly Part B Premium |
|---|---|---|
| ≤ $109,000 | ≤ $218,000 | $202.90 |
| > $109,000 - < $137,000 | > $218,000 - < $274,000 | $284.10 |
| > $137,000 - < $171,000 | > $274,000 - < $342,000 | $405.80 |
| > $171,000 - < $205,000 | > $342,000 - < $410,000 | $527.50 |
| > $205,000 - < $500,000 | > $410,000 - < $750,000 | $649.20 |
| > $500,000 | > $750,000 | $689.90 |
Appeal IRMAA
If your income dropped significantly due to retirement, divorce, or another qualifying life event after the look-back year, you may appeal your IRMAA determination. Contact the Social Security Administration and request a review using Form SSA-44.
Part B Excess Charges: A Hidden Cost Risk
Providers who do not accept Medicare assignment are permitted to charge up to 15% above the Medicare-approved rate for a service. These are called Part B excess charges, and you pay them entirely out of pocket.
For example, if Medicare approves $500 for a procedure and your provider charges $575 (the 15% maximum), you still owe your 20% coinsurance on the approved amount plus the full $75 excess charge. Over multiple specialist visits, this adds up quickly.
Avoid Excess Charges
Before scheduling non-emergency care, always ask whether your provider accepts Medicare assignment. You can verify this through the Medicare Provider Directory at Medicare.gov or by calling your provider's billing office directly.
Medicare Savings Programs (MSPs): Assistance for Low-Income Beneficiaries
If your income and resources are limited, Medicare Savings Programs may significantly reduce what you pay for Part B. These state-administered, federally supported programs can cover your Part B premium.
Depending on the specific program level, MSPs may also help with your deductible and coinsurance. There are four MSP levels: Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), Qualifying Individual (QI), and Qualified Disabled and Working Individuals (QDWI).
Each has different income thresholds and benefit levels. To check your eligibility, contact your state's Medicaid office or the Social Security Administration. You can also explore the Medicare Savings Programs page for a breakdown of income limits and what each tier covers in your state.
Pro Tip
Check whether your doctors and any specialists you see regularly accept Medicare assignment before your appointment, not after you receive a bill. Simply call the provider's billing department and ask directly: "Do you accept Medicare assignment?" This one question can protect you from unexpected excess charges that standard Part B coverage won't absorb.
When and How to Enroll in Medicare Part B
Your first and most important enrollment window is the Initial Enrollment Period (IEP), a 7-month window that begins 3 months before the month you turn 65, includes your birthday month, and extends 3 months after.
Enrolling in the first three months of this window ensures your coverage starts without delay.
General Enrollment Period & Penalties
If you miss your IEP without qualifying coverage, you can sign up during the General Enrollment Period (GEP), from January 1 to March 31 each year. Coverage won't begin until July 1, and you may face a late enrollment penalty, an additional 10% added to your premium for each full 12-month period you went without Part B when eligible.
A Special Enrollment Period (SEP) is available if you delayed Part B enrollment because you were covered by an employer-sponsored health plan through your own or a spouse's active employment.
You have 8 months after that employer coverage ends to enroll in Part B without penalty. To enroll, you can apply online at SSA.gov, visit your local Social Security office, or call the SSA directly. You can also learn about the process through the Medicare Part B enrollment page for step-by-step guidance.
What Does Medicare Part B Not Cover?
Knowing what Part B excludes is just as valuable as knowing what it includes. Several common healthcare needs fall entirely outside its scope:
Routine dental care: Cleanings, fillings, extractions, and dentures are not covered unless dental care is directly tied to a covered medical procedure.
Routine vision care: Standard eye exams and eyeglasses are excluded, though Part B does cover certain eye-related conditions like glaucoma screening and cataract surgery when medically necessary.
Hearing aids: Part B does not cover hearing aids or the routine fitting exams required for them.
Prescription drugs taken at home: Medications you pick up at a pharmacy are covered under Part D, not Part B. (Part B does cover certain drugs administered in a clinical setting, such as infusions.)
Long-term custodial care: Assistance with daily activities in a nursing home or assisted living facility is not a Part B benefit.
Cosmetic procedures: Any procedure that is not medically necessary is excluded.
This gap is covered in the cost section above; see the Managing Part B Gaps section for supplemental coverage options.
Managing Part B Gaps: Medigap vs. Medicare Advantage
Because Part B exposes you to uncapped 20% coinsurance with no annual out-of-pocket maximum, the question isn't really whether you need supplemental coverage, it's which type fits your situation best.
Medicare Supplement (Medigap) plans are sold by private insurers and are specifically designed to fill the gaps left by Original Medicare. Depending on the plan you choose, Medigap can cover your Part B deductible, coinsurance, and even excess charges, giving you predictable, manageable costs.
Medigap Plans
Medigap plans work with any provider nationwide who accepts Medicare, with no network restrictions. This offers broad flexibility for those who travel or prefer specific doctors.
Medicare Advantage (Part C) plans bundle Part A, Part B, and often Part D into a single private plan. They typically include a set annual out-of-pocket maximum and may offer extra benefits like dental, vision, and hearing coverage.
However, they often require you to use network providers and may involve prior authorization requirements for certain services. Choosing between Medigap and Medicare Advantage comes down to your health needs, how frequently you see specialists, your preferred doctors, and your monthly budget.
Choosing Supplemental Coverage
If you travel frequently or want nationwide provider flexibility, Medigap often offers more freedom. If you prefer lower premiums and are comfortable within a local network, Medicare Advantage may be a better fit.
Tips for Maximizing Your Medicare Part B Benefits
Getting the most from your Part B coverage is largely about being proactive rather than reactive. Here are practical steps that make a real difference:
Schedule your Annual Wellness Visit every year. This preventive visit is covered at no cost to you and gives your doctor a chance to update your health plan, review medications, and flag any concerns early.
Confirm Medicare assignment with every provider. Before seeing a new doctor or specialist, verify they accept Medicare assignment to avoid unexpected excess charges.
Review your Medicare Summary Notice regularly. This document summarizes what Medicare was billed and what it paid on your behalf. Reviewing it helps you catch billing errors and understand your share of costs.
Use covered screenings. Part B covers a range of preventive screenings, from bone density tests to diabetes screenings, at no cost when ordered appropriately. Taking advantage of these can catch conditions early.
Explore supplemental coverage options. If you haven't already, consider how a Medigap plan or Medicare Advantage plan could cap your out-of-pocket exposure and reduce financial uncertainty.
Who This Guide Is For
This article is written for people who need clear, accurate information about how Medicare Part B works in 2026, what it costs, what it covers, and how to enroll without making costly mistakes.
This Guide Is Perfect For You If...
You're turning 65 soon and trying to understand what Medicare Part B is and whether you need it.
You're already enrolled in Part B but want to make sure you understand your out-of-pocket costs and coverage limits.
You missed your Initial Enrollment Period and are trying to figure out your options and any penalties you may face.
You're helping a parent or spouse enroll in Medicare and want to explain Part B clearly and accurately.
You're reviewing supplemental options like Medigap or Medicare Advantage to protect against Part B's uncapped 20% coinsurance.
You have a higher income and want to understand whether IRMAA applies to your situation.
This Might Not Be For You If...
You're enrolled in Medicaid only and not yet approaching Medicare eligibility; you may want to read about Medicare vs. Medicaid differences first.
You're already well-versed in Part B and are specifically looking for details on Medicare Advantage plan comparison; the Medicare Advantage Plans section may be more useful.
You're under 65 and not yet eligible based on disability or ESRD; in that case, review Medicare eligibility requirements to understand when and how you qualify.
Frequently Asked Questions About Medicare Part B
Conclusion: Navigating Your Medicare Part B Coverage
Medicare Part B forms the backbone of your day-to-day medical care in retirement. From doctor visits and lab work to preventive screenings and outpatient procedures, it covers the services you're most likely to use throughout the year.
Understanding exactly how it works, and what it costs, puts you in a far stronger position to plan confidently. Proactive planning around premiums, the deductible, and uncapped coinsurance is essential.
Part B Alone is Not Full Protection
Layer in the potential for IRMAA surcharges, excess charges from non-assignment providers, and the absence of any out-of-pocket cap, and it becomes clear that Part B alone doesn't provide complete financial protection.
Proactive planning makes a measurable difference. That means enrolling on time, confirming provider assignment status, using your no-cost preventive benefits every year, and seriously evaluating whether a Medigap or Medicare Advantage plan belongs in your overall coverage strategy.
If you have specific questions about your coverage options, the Social Security Administration and CMS offer free resources and counseling programs. You can also explore the full range of Medicare benefits available to help you make a well-informed decision, because getting this right matters for both your health and your financial peace of mind.
Related Articles
Have Medicare questions?
Our licensed Medicare agents are available to help you find the right coverage.