When you begin your Medicare journey, you will quickly learn about its different “parts.” While Part A covers hospital stays, Medicare Part B is the cornerstone of your everyday medical coverage. It is the part of Original Medicare that helps pay for the services you need to stay healthy, from doctor visits to outpatient care.
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Understanding what Part B covers, what it costs, and where it leaves gaps is essential for managing your healthcare and your budget in retirement. This guide will walk you through the key components of Medicare Part B.
Why Medicare Part B Matters
Think of Medicare Part B as your medical insurance. It provides the coverage you need for services outside of an inpatient hospital stay. Without Part B, you would be responsible for the full cost of doctor appointments, preventive screenings, and medical equipment. Enrolling in Part B is a crucial step to ensure you have comprehensive health coverage when you need it most.
What Medicare Part B Covers
Medicare Part B helps cover a wide range of medically necessary and preventive services.
Medically necessary services are those required to diagnose or treat a medical condition. This includes:
- Doctor services (in their office, a hospital, or other settings)
- Outpatient hospital services
- Durable Medical Equipment (DME), such as walkers, wheelchairs, and oxygen
- Ambulance services
- Clinical research
- Mental health services (outpatient)
- Second opinions before surgery
- Some outpatient prescription drugs (usually those administered by a professional)
Preventive services are designed to prevent illness or detect it at an early stage. Many of these services are covered at no cost to you if you use a provider who accepts Medicare. This includes:
Medicare Part B Premiums: What You Will Pay Each Month
You must pay a monthly premium for Medicare Part B. For most people, this premium is deducted automatically from their Social Security benefit payment.
The Centers for Medicare & Medicaid Services (CMS) sets the premium and deductible amounts each year. For 2026, the standard monthly Part B premium is $202.90.
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However, your premium may be higher based on your income. This adjustment is known as the Income-Related Monthly Adjustment Amount (IRMAA). Medicare uses the modified adjusted gross income reported on your tax return from two years prior.
For example, in 2026, individuals with a 2024 income greater than $109,000 (or $218,000 for married couples filing jointly) will pay a higher premium. If your income has decreased since then due to a life-changing event (like retirement), you may be able to appeal the IRMAA determination.
Understanding the Part B Deductible
In addition to your monthly premium, you must also meet an annual deductible before Medicare begins to pay its share for most services. For 2026, the annual Medicare Part B deductible is $283.
You pay 100 percent of the costs for most Part B-covered services until you have spent this amount out-of-pocket. After you meet your deductible, you move on to paying coinsurance.
Coinsurance and Out-of-Pocket Costs
Once your Part B deductible is met, you are responsible for a portion of the cost for services, which is called coinsurance.
For most Part B services, you will pay 20 percent of the Medicare-approved amount. Medicare pays the remaining 80 percent.
This 20 percent coinsurance can be a major financial concern, especially if you require frequent medical care or a significant outpatient procedure. Unlike most private insurance plans, Original Medicare (Parts A and B) has no annual cap or out-of-pocket maximum. This means there is no limit to what you could owe in coinsurance costs in a single year.
When and How to Enroll in Medicare Part B
Enrolling on time is critical to avoid lifelong penalties. Most people first become eligible for Medicare during their Initial Enrollment Period (IEP). This is a 7-month window that includes:
- The 3 months before your 65th birthday
- The month of your 65th birthday
- The 3 months after your 65th birthday
If you are already receiving Social Security benefits, you will likely be enrolled in Part A and Part B automatically. If not, you will need to sign up yourself through the Social Security Administration.
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If you miss your IEP, you may have to wait for the General Enrollment Period (GEP), which runs from January 1 to March 31 each year, with coverage not starting the first of the following month. If you enroll late, you may face a permanent late enrollment penalty on your monthly premium.
Some individuals may qualify for a Special Enrollment Period (SEP), such as when you or your spouse are still working and have coverage through that employer.
What Is Not Covered by Part B
It is just as important to know what Part B does not cover. These are some of the most common services that Original Medicare excludes:
- Routine dental care, dentures, or cleanings
- Eye exams for prescription glasses (and the glasses themselves)
- Hearing aids and the exams for fitting them
- Long-term care (custodial care)
- Cosmetic surgery
- Most prescription drugs you take at home (this is covered by Medicare Part D)
How Medicare Supplement (Medigap) or Advantage Plans Work with Part B
This is where you can take control of your healthcare costs. Because Part B leaves you exposed to a deductible and uncapped 20 percent coinsurance, many people choose additional coverage.
- Medicare Advantage (Part C) plans are an alternative to Original Medicare. They are private plans that bundle Parts A, B, and usually D (drugs) into one plan.
- Medicare Supplement (Medigap) plans work with Original Medicare. These plans are sold by private insurance companies and are designed specifically to “fill the gaps” left by Parts A and B.
A Medigap plan can help pay for your Part B coinsurance, your Part B deductible, and other costs. This provides incredible peace of mind by making your healthcare costs predictable. By paying your Medigap premium, you can significantly reduce or even eliminate your out-of-pocket costs for Medicare-covered services.
This is often the most effective way to protect yourself from the unlimited 20 percent coinsurance.
How to Get the Most Out of Your Medicare Part B Coverage
To maximize your benefits, be proactive.
- Use Your Preventive Services: Take advantage of your annual “Wellness” visit and covered screenings. Early detection is key to good health.
- Ask About Assignment: Before receiving a service, always ask your doctor if they “accept Medicare assignment.” This means they agree to accept the Medicare-approved amount as full payment and will not charge you more.
- Cover the Gaps: The 20 percent coinsurance and the annual deductible are significant costs that can add up quickly. The best way to manage these unpredictable expenses is to pair your Original Medicare with a Medicare Supplement plan.
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