Medicare Part B, your medical insurance coverage, is essential for covering doctor visits, outpatient services, and preventive care. Understanding Part B—what it covers, what it costs, and how to maximize its benefits—helps you make informed healthcare decisions and manage your Medicare expenses effectively. This comprehensive guide covers everything you need to know about Medicare Part B for 2026.
What Is Medicare Part B?
Medicare Part B is medical insurance that covers doctor services, outpatient care, preventive services, and durable medical equipment. While Part A focuses on hospital stays, Part B covers the healthcare services you use most frequently—doctor visits, lab tests, X-rays, and preventive screenings.
Unlike Part A, which is premium-free for most beneficiaries, nearly everyone pays a monthly premium for Part B. The standard Part B premium for 2026 is $202.90 per month, though higher-income beneficiaries pay more through Income-Related Monthly Adjustment Amounts (IRMAA).
🧠 Need a refresher? Check out our Guide to the Four Parts of Medicare!
What Does Medicare Part B Cover?
Part B covers two main categories of services: medically necessary services and preventive services.
Medically Necessary Services
These are services or supplies needed to diagnose or treat your medical condition that meet accepted standards of medical practice:
- Doctor visits: Office visits, consultations, and follow-up appointments with physicians and specialists
- Outpatient services: Medical care you receive without being admitted to a hospital, including emergency room visits that don’t result in admission
- Lab tests and diagnostic services: Blood tests, X-rays, MRIs, CT scans, and other imaging services
- Outpatient surgery: Surgical procedures performed in outpatient settings
- Mental health care: Outpatient mental health services and counseling
- Clinical research: Participation in Medicare-approved clinical trials
- Ambulance services: Emergency and non-emergency transportation when medically necessary
- Second surgical opinions: When you want another doctor’s opinion about surgery
Durable Medical Equipment (DME)
Part B covers durable medical equipment prescribed by your doctor for use in your home:
- Wheelchairs and walkers
- Hospital beds and bedside commodes
- Oxygen equipment and supplies
- Continuous Positive Airway Pressure (CPAP) devices for sleep apnea
- Blood sugar monitors and test strips for diabetes
- Nebulizers and nebulizer medications
Preventive Services
Part B covers numerous preventive services at no cost to you when you see a provider who accepts assignment. These services help detect health problems early when treatment is most effective:
- “Welcome to Medicare” preventive visit: One-time comprehensive visit within the first 12 months of Part B coverage
- Annual wellness visits: Yearly appointments to create or update a personalized prevention plan
- Cardiovascular disease screenings: Blood tests to check cholesterol and lipid levels
- Diabetes screenings: Tests to detect diabetes and pre-diabetes
- Cancer screenings: Mammograms, colonoscopies, Pap tests, prostate cancer screenings, and lung cancer screenings
- Bone mass measurements: Tests to detect osteoporosis
- Depression screenings: Annual screening for depression
- Vaccinations: Flu shots, pneumonia vaccines, Hepatitis B shots, and COVID-19 vaccines
Important: You pay nothing for preventive services if your provider accepts assignment and you haven’t met your Part B deductible yet. The deductible doesn’t apply to preventive services.
Part B Prescription Drug Coverage
Part B covers certain prescription drugs administered by a healthcare professional in an outpatient setting:
- Injectable medications given in a doctor’s office
- Chemotherapy drugs
- Certain oral cancer medications
- Immunosuppressive drugs (if Part B pays for your transplant)
- Injectable osteoporosis drugs for homebound women
- Blood clotting factors for hemophilia
- Insulin used with an insulin pump covered as durable medical equipment
Insulin Cost Cap: If you use an insulin pump covered under Part B, your cost for a month’s supply of Part B-covered insulin for your pump can’t be more than $35 in 2026.
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What Medicare Part B Does NOT Cover
Understanding Part B’s limitations helps you plan for additional coverage needs:
- Routine dental care, dentures, and dental work
- Routine eye exams, eyeglasses, and contact lenses (except after cataract surgery)
- Hearing aids and hearing exams for fitting hearing aids
- Most prescription drugs you pick up at a pharmacy (covered by Part D)
- Long-term care or custodial care
- Cosmetic surgery
- Acupuncture (except for chronic lower back pain)
- Most healthcare outside the United States
2026 Medicare Part B Costs: What You’ll Pay
Understanding your Part B costs is essential for budgeting your healthcare expenses.
Standard Monthly Premium for 2026
The standard monthly premium for Medicare Part B is $202.90 in 2026, an increase of $17.90 from $185.00 in 2025. This represents nearly a 10% increase.
Most beneficiaries pay this standard premium if their modified adjusted gross income (MAGI) is:
- $109,000 or less for individual filers
- $218,000 or less for married couples filing jointly
Your premium is typically deducted automatically from your Social Security check each month.
The Annual Deductible
The Part B deductible for 2026 is $283, up $26 from $257 in 2025. Unlike Part A’s benefit period-based deductible, the Part B deductible is based on the calendar year. You pay this deductible once per year (January through December), and then Part B coverage begins for the remainder of the year.
The 20% Coinsurance
After meeting your deductible, you typically pay 20% of the Medicare-approved amount for Part B services. Medicare pays the other 80%.
Example: If your doctor’s office visit has a Medicare-approved amount of $100, and you’ve already met your deductible, you pay $20 and Medicare pays $80.
Important: There’s no annual out-of-pocket maximum with Original Medicare Part B. The 20% coinsurance continues for all covered services throughout the year, which is why many people choose Medicare Supplement insurance (Medigap) to help cover these costs.
Income-Related Monthly Adjustment Amount (IRMAA): Higher Premiums for Higher Earners
Since 2007, Medicare Part B premiums have been income-based. Approximately 8% of Medicare beneficiaries pay higher premiums due to their income levels. These surcharges are called Income-Related Monthly Adjustment Amounts (IRMAA).
How IRMAA Works
Your IRMAA is determined by your modified adjusted gross income (MAGI) from your tax return from two years prior. For 2026 premiums, Medicare uses your 2024 tax return.
2026 Part B IRMAA Brackets
Here are the complete Part B premium amounts for 2026 based on income:
For Individual Filers:
- $109,000 or less: $202.90/month
- $109,001 – $137,000: $284.10/month (+$81.20 IRMAA)
- $137,001 – $171,000: $405.80/month (+$202.90 IRMAA)
- $171,001 – $205,000: $527.50/month (+$324.60 IRMAA)
- $205,001 – $499,999: $649.20/month (+$446.30 IRMAA)
- $500,000 or more: $689.90/month (+$487.00 IRMAA)
For Married Couples Filing Jointly:
- $218,000 or less: $202.90/month
- $218,001 – $274,000: $284.10/month (+$81.20 IRMAA)
- $274,001 – $342,000: $405.80/month (+$202.90 IRMAA)
- $342,001 – $410,000: $527.50/month (+$324.60 IRMAA)
- $410,001 – $749,999: $649.20/month (+$446.30 IRMAA)
- $750,000 or more: $689.90/month (+$487.00 IRMAA)
For Married Couples Filing Separately (lived together during the year):
- $109,000 or less: $202.90/month
- $109,001 – $390,999: $649.20/month (+$446.30 IRMAA)
- $391,000 or more: $689.90/month (+$487.00 IRMAA)
IRMAA Examples
Example 1: Retired couple with pension and investment income
Robert and Susan file jointly. Their 2024 MAGI was $250,000 (between $218,001 and $274,000). In 2026, they each pay $284.10 per month for Part B, totaling $568.20 monthly for both.
Annual Part B cost for the couple: $6,818.40
Example 2: High-income individual
Margaret is single and had a 2024 MAGI of $185,000 (between $171,001 and $205,000). She pays $527.50 per month for Part B in 2026.
Annual Part B cost: $6,330
Appealing Your IRMAA Determination
You can appeal your IRMAA determination if you experienced a life-changing event that reduced your income:
- Marriage, divorce, or death of a spouse
- Work stoppage or reduction
- Loss of income-producing property due to disaster or other event
- Loss of pension income
- Employer settlement payment
Contact Social Security at 1-800-772-1213 to request a reconsideration using form SSA-44.
How to Enroll in Medicare Part B
Most people are automatically enrolled in Part B when they turn 65 if they’re already receiving Social Security benefits. However, you can decline Part B if you have other creditable coverage.
Initial Enrollment Period
If you’re not automatically enrolled, your Initial Enrollment Period (IEP) for Part B is a 7-month window:
- 3 months before you turn 65
- Your birthday month
- 3 months after you turn 65
Special Enrollment Period
If you delay enrolling in Part B because you have coverage through current employment (yours or your spouse’s), you can enroll during a Special Enrollment Period. This period lasts for 8 months after:
- Your employment ends, or
- Your group health coverage ends (whichever comes first)
General Enrollment Period
If you miss your IEP and don’t qualify for a Special Enrollment Period, you can enroll during the General Enrollment Period (January 1 – March 31 each year). However, you may face late enrollment penalties.
Late Enrollment Penalties for Part B
If you don’t enroll in Part B when you’re first eligible and you don’t have other creditable coverage, you’ll pay a late enrollment penalty for as long as you have Part B.
How the Penalty Works
Your premium increases by 10% for each full 12-month period you could have had Part B but didn’t sign up.
Example: If you were eligible for Part B at age 65 but didn’t enroll until age 67 (2 years late), your penalty would be 20% (10% × 2 years).
With the standard 2026 premium of $202.90, a 20% penalty adds $40.58 per month, bringing your total monthly premium to $243.48. This penalty continues for life.
📆 Don’t miss critical enrollment deadlines! Check out our Key Medicare Dates and Deadlines resource.
Medicare Assignment: Controlling Your Costs
Understanding Medicare assignment helps you manage your Part B out-of-pocket costs.
What Is Assignment?
Assignment means your doctor or supplier agrees to accept the Medicare-approved amount as full payment for covered services. Providers who accept assignment:
- Agree to be paid the Medicare-approved amount directly by Medicare
- Bill you only for the Part B deductible and 20% coinsurance
- File Medicare claims on your behalf
Providers Who Don’t Accept Assignment
If your provider doesn’t accept assignment, they can charge up to 15% more than the Medicare-approved amount. This is called the “limiting charge.”
Example: If the Medicare-approved amount for a service is $100:
- With a provider who accepts assignment: You pay $20 (20% coinsurance after deductible)
- With a provider who doesn’t accept assignment: You could pay up to $35 (20% of $115, which is $100 + 15% limiting charge)
Tip: Always ask if your provider accepts Medicare assignment before receiving services. Most providers do accept assignment.
Part B and Medicare Supplement Insurance (Medigap)
Medicare Supplement insurance helps cover Part B’s gaps, including the deductible, 20% coinsurance, and excess charges.
All standardized Medigap plans cover the 20% Part B coinsurance. Most plans also cover:
- Part B excess charges (Plans F, G, and N)
- Part B deductible (Plans C and F, though these are only available to those eligible for Medicare before 2020)
With most Medigap plans, you’ll pay no out-of-pocket costs when visiting doctors and receiving Part B services (after paying your monthly Medigap premium).
Part B and Medicare Advantage Plans
If you choose a Medicare Advantage Plan instead of Original Medicare:
- You still have Part B coverage (the private plan administers it)
- You must continue paying your Part B premium
- The plan may charge different cost-sharing (copays instead of 20% coinsurance)
- You’ll have an annual out-of-pocket maximum ($9,250 for in-network services in 2026)
- You may need referrals to see specialists
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Maximizing Your Part B Benefits
Get the most value from your Part B coverage with these strategies:
Take Advantage of Free Preventive Services
Schedule your annual wellness visit and take advantage of free screenings for cancer, cardiovascular disease, diabetes, and other conditions. These services cost you nothing and can detect health problems early.
Use Providers Who Accept Assignment
Find doctors and suppliers who accept Medicare assignment to avoid paying excess charges. Use Medicare’s Physician Compare tool at Medicare.gov to find participating providers.
Understand Your Medicare Summary Notice
Review your Medicare Summary Notice (MSN) every three months to ensure charges are accurate and you’re not being billed for services Medicare should cover.
Consider Supplemental Coverage
Evaluate whether a Medicare Supplement plan or Medicare Advantage plan makes sense for your situation to help manage the 20% coinsurance and lack of an out-of-pocket maximum with Original Medicare.
Common Medicare Part B Questions
Can I have Part B without Part A?
Yes, but most people have both. You might choose Part B only if you’re still working and covered by employer insurance, but this is uncommon.
Does Part B cover prescriptions I pick up at the pharmacy?
No. Part B only covers certain drugs administered by healthcare professionals in outpatient settings. For pharmacy prescriptions, you need Medicare Part D coverage.
What if I can’t afford the Part B premium?
You may qualify for a Medicare Savings Program through your state, which helps pay Part B premiums and other Medicare costs for those with limited income and resources. Contact your State Health Insurance Assistance Program (SHIP) for help.
Can I drop Part B if I have other coverage?
Yes, but be careful. You can drop Part B without penalty if you have creditable coverage through current employment. However, dropping Part B when you don’t have other creditable coverage will result in late enrollment penalties when you re-enroll.
The Bottom Line on Medicare Part B
Medicare Part B is essential coverage for outpatient services, doctor visits, and preventive care. While the monthly premium has increased to $202.90 for 2026, and high-income beneficiaries pay significantly more through IRMAA, Part B provides valuable coverage for the healthcare services you use most frequently.
Understanding Part B’s coverage, costs, and limitations helps you make informed decisions about supplemental insurance and manage your healthcare expenses effectively. The 20% coinsurance with no out-of-pocket maximum makes supplemental coverage—either through a Medigap policy or Medicare Advantage plan—worth serious consideration for most beneficiaries.
Take advantage of Part B’s excellent preventive services at no cost to you, always verify your providers accept Medicare assignment, and review your coverage options annually to ensure you have the protection you need.
Timothy Gibson is an independent licensed insurance broker with 8 years of experience helping individuals and couples navigate Medicare. He can help you understand Part B coverage, explain IRMAA implications, and find supplemental insurance that fits your health needs and budget.
No cost. No pressure. Just knowledgeable advice tailored to you.