What does Medicare Part B cover?
Medicare Part B is your medical insurance. It covers doctor visits, outpatient care, preventive services, durable medical equipment, mental health, ambulance to the nearest appropriate facility, and most things that aren't an inpatient hospital stay. The standard 2026 Part B premium is $202.90 — more if your income triggers IRMAA. Part B has a $283 annual deductible and 20% coinsurance for most services. Critically, Original Medicare has NO annual out-of-pocket cap. Medigap or Medicare Advantage with a low out-of-pocket cap is how most people limit their exposure.
Dr. Ed Weir, PhD · 20 years inside Social Security · "Former" Sergeant, USMC
Updated April 2026
What does Medicare Part B cover?
Part B is medical insurance. Standard 2026 premium is $202.90/month, more for higher incomes (IRMAA starts at $109,000 for singles, $218,000 for joint filers in 2026). Annual deductible is $283. After the deductible, you typically pay 20% coinsurance for covered services. Original Medicare has NO annual out-of-pocket cap. Most people add a Medigap supplement or pick a Medicare Advantage plan to limit what they could pay in a bad year.
This whole page is about Medicare Part B
Free help understanding Part B
Part B costs surprise people — the 20% coinsurance, the IRMAA surcharge, the lack of an out-of-pocket cap. Chapter Medicare's licensed advisors give you a free comparison of how to limit your exposure.
Here's what to know about Part B.
Confused about what Part B costs you and covers? Here's the order I'd take.
1. Enroll in Part B during your IEP — late enrollment is permanent
Sign up for Part B during your 7-month Initial Enrollment Period unless you have qualifying employer coverage. The Part B late-enrollment penalty is 10% added to your premium for every full 12 months you were eligible but did not enroll — permanent for life.
If you have group health insurance through current active employment with 20+ employees, you can usually delay Part B safely and use the 8-month SEP when that coverage ends. COBRA, retiree coverage, severance plans, and ACA marketplace plans do NOT count.
Apply for Medicare › ›2. Plan around the deductible and 20% coinsurance
After meeting the $283 annual deductible in 2026, you typically pay 20% coinsurance for covered services and Medicare pays the other 80%. There's no upper limit on the 20% coinsurance under Original Medicare alone.
Most people add either a Medigap supplement (covers the 20% coinsurance and Part B deductible depending on plan letter) or pick a Medicare Advantage plan that caps annual out-of-pocket spending.
3. Check whether your income triggers IRMAA — and appeal if income dropped
If your modified adjusted gross income from two years ago was above $109,000 (single) or $218,000 (joint) in 2026, you'll pay an Income-Related Monthly Adjustment Amount (IRMAA) on top of the standard Part B premium. IRMAA also applies to Part D premiums.
If your income has dropped because of a life-changing event — retirement, divorce, death of a spouse, work reduction — you can request reconsideration with Form SSA-44. Most newly retired people qualify for an IRMAA reduction the first year they apply. SHIP at can help fill out the form.
Form SSA-44 › ›4. Don't ignore that Original Medicare has NO annual out-of-pocket cap — you need a supplement or MA plan
Original Medicare (Parts A and B alone) has NO upper limit on what you could pay in a year for the 20% Part B coinsurance, Part A coinsurance for long stays, and Part B excess charges. A serious medical event under Original Medicare with no supplement could expose you to tens of thousands in out-of-pocket costs.
Two paths to limit exposure: add a Medigap supplement (caps your Part B coinsurance and absorbs the Part A deductible depending on plan letter), OR enroll in a Medicare Advantage plan that caps annual out-of-pocket spending. Free comparison from SHIP at or Chapter Medicare at (352) 841-0632.
Free Medicare help › ›2026 Medicare Part B by the numbers
Which of these fits your situation?
Part B does most of the heavy lifting in Medicare — and it costs the most for most people. Pick what fits.
I'm turning 65 — when do I enroll in Part B?During your IEP unless you have qualifying employer coverage
Sign up during your 7-month Initial Enrollment Period unless you have group health insurance through current active employment with 20+ employees. The Part B late-enrollment penalty is permanent.
If you're already collecting Social Security at 65, SSA enrolls you automatically in Parts A and B and the Part B premium gets deducted from your Social Security check. If you're delaying Social Security past 65, you have to enroll in Part B yourself.
The most expensive Medicare mistake I saw at SSA was people delaying Social Security to 70 and forgetting Medicare runs on its own clock. The Part B late-enrollment penalty is permanent and adds up fast.
What does Part B actually cover?Doctor visits, outpatient care, preventive services, durable medical equipment
Part B covers a long list: doctor visits (primary care and specialists), outpatient hospital care, preventive services (annual wellness visit, screenings, vaccines), durable medical equipment (wheelchairs, walkers, home oxygen, CPAP), ambulance to the nearest appropriate facility, mental health services (outpatient and limited inpatient), some home health, and outpatient diabetes supplies.
Part B does NOT cover: inpatient hospital stays (that's Part A), most prescription drugs (that's Part D), routine dental, vision, or hearing aids, long-term custodial care, or care outside the U.S. (limited exceptions).
I'm working past 65 with employer coverage — should I delay Part B?Usually yes, IF the employer has 20+ employees — with caveats
If you (or your spouse) have group health insurance through current active employment with 20+ employees, you can usually delay Part B safely. When that coverage ends, an 8-month Special Enrollment Period opens for Part B.
Key caveats: employers under 20 employees — Medicare typically becomes the primary payer at 65, and you may need Part B even if your group plan continues. HSA contributors must stop contributing once Medicare starts. COBRA, retiree coverage, and severance plans do NOT count as creditable employer coverage. Confirm with HR before assuming you can delay.
If your employer has fewer than 20 employees, the small-employer rule applies and Medicare becomes the PRIMARY payer at 65. Confirm with HR — don't assume your employer plan still covers you the way it did before 65.
I'm worried about the 20% coinsurance with no out-of-pocket capYou have two paths: Medigap supplement OR Medicare Advantage
Original Medicare alone has NO upper limit on what you could pay in a year for the 20% Part B coinsurance and Part A coinsurance. A bad cancer year, a cardiac event, or extended outpatient treatment could expose you to tens of thousands.
Two ways to limit exposure: (1) add a Medigap supplement — most plan letters cover the Part B coinsurance and absorb the Part A deductible; or (2) enroll in a Medicare Advantage plan that bundles A, B, and (usually) D and caps annual out-of-pocket spending. Talk to SHIP at or Chapter Medicare at (352) 841-0632 for unbiased help comparing.
I won't tell you which path to pick — it depends on your health, providers, prescriptions, and state. But staying with Original Medicare alone with no supplement is a real risk most people shouldn't take.
My income changed — can I appeal IRMAA?Yes — Form SSA-44 for life-changing events
IRMAA is based on your tax return from two years ago. If your income has dropped because of a life-changing event — retirement, work reduction, divorce, death of a spouse, loss of pension or rental income — you can request reconsideration with Form SSA-44.
The form lets you tell SSA what your current income looks like and document the qualifying event. Most newly retired people qualify for an IRMAA reduction the first year they apply. SHIP at can help fill it out.
Most retirees never know about Form SSA-44. If you're newly retired, file it with your IRMAA notice. The reduction can be hundreds of dollars per month.
Is the Part B premium deducted from my Social Security check?Yes — if you're collecting Social Security
If you're collecting Social Security and enrolled in Part B, the standard $202.90 2026 premium (plus any IRMAA surcharge) is deducted from your monthly Social Security payment. You don't get a separate bill.
If you're not yet collecting Social Security, Medicare bills you directly — quarterly by default, with options for monthly payments or automatic bank deduction. Sign up for Medicare Easy Pay or pay through your bank's bill-pay to avoid late notices.
I'm helping a parent with Part B costs and IRMAABystander — I'm not the one paying
If you're helping a parent, two cost levers matter most: (1) IRMAA — if their income dropped due to retirement, divorce, or death of a spouse, file Form SSA-44 to request reduction; (2) Medicare Savings Program (MSP) — if income is modest, MSP through their state Medicaid agency can pay the full Part B premium. Many people qualify and never apply.
Form SSA-1696 lets you act as their authorized representative on the SSA side. SHIP at can help you with both for free.
My situation is different from theseTell me what's specific to you
Part B questions get specific in lots of ways: federal retirees with FEHB, military retirees with TRICARE for Life, expat retirees living abroad, people on dialysis (ESRD), and people transitioning from disability-based Medicare to age-based at 65 all have their own coordination rules.
For anything outside the standard at-65 script, a free SHIP call at or Chapter Medicare at (352) 841-0632 is faster than guessing.
Part B doesn't stand alone. Here's what works alongside.
Part B is one piece of the picture. Other coverage and assistance programs can lower what you pay.
Medicare basics (Hub)
Part B is one of the four parts. The hub explains how A, B, C, and D fit together and what the major decisions look like.
Medicare Part A
Part A is hospital insurance — the inpatient side. Part B covers everything else (doctors, outpatient, preventive). Most people need both.
Medicare enrollment periods
Part B has the toughest late-enrollment penalty in Medicare. Knowing your IEP, GEP, and SEP windows is essential to avoid permanent surcharges.
Medicare Savings Program (MSP)
If your income is modest, MSP can pay your Part B premium ($202.90/month in 2026) and other Medicare cost-sharing. State Medicaid agencies run it.
IRMAA on Part B and Social Security
IRMAA is the income-related Medicare surcharge that stacks on top of the standard Part B premium. Form SSA-44 lets you appeal if your income dropped because of a life-changing event.
Medigap (Medicare Supplement)
A Medigap supplement caps the 20% Part B coinsurance and absorbs the Part A deductible (depending on plan letter). Your one-time guaranteed-issue Medigap window starts when you first enroll in Part B at 65.
Medicare Part B questions I get most often
What does Part B cover?
Part B covers doctor visits, outpatient hospital care, preventive services (annual wellness, screenings, vaccines), durable medical equipment (wheelchairs, walkers, oxygen, CPAP), ambulance to the nearest appropriate facility, mental health services (outpatient and limited inpatient), some home health, and outpatient diabetes supplies.
Part B does NOT cover inpatient hospital stays (Part A), most prescription drugs (Part D), routine dental, vision, or hearing aids, long-term custodial care, or care outside the U.S. (limited exceptions).
How much does Part B cost in 2026?
Standard 2026 Part B premium is $202.90 per month. Annual deductible is $283. After the deductible, you typically pay 20% coinsurance.
If your modified adjusted gross income from two years ago was above $109,000 (single) or $218,000 (joint), an IRMAA surcharge stacks on top of the standard premium — ranging from a small adjustment up to several hundred dollars per month at the highest income tiers.
Do I have to enroll in Part B?
Technically Part B is voluntary — but if you're eligible and don't have qualifying employer coverage, the late-enrollment penalty makes it almost always wrong to skip. The Part B late-enrollment penalty is 10% added to your premium for every full 12 months you were eligible but did not enroll, applied for life.
The limited situations where delaying Part B is reasonable: active employer coverage from a 20+ employee employer, TRICARE for Life (for military retirees), or VA-only coverage in some cases. Confirm before assuming.
What is IRMAA and how do I appeal it?
IRMAA is the Income-Related Monthly Adjustment Amount — an extra charge on top of your Part B and Part D premiums for people whose income is above set thresholds. The 2026 starting threshold is $109,000 (single) and $218,000 (joint).
IRMAA is based on your tax return from two years ago. If your income has dropped because of a life-changing event — retirement, work reduction, divorce, death of a spouse, loss of pension or rental income — you can request reconsideration with Form SSA-44. SHIP at can help.
Do I pay 20% on every service?
After meeting the $283 annual deductible, you typically pay 20% coinsurance for most Part B services and Medicare pays 80% of the Medicare-approved amount.
A few preventive services have $0 cost-sharing — annual wellness visit, many screenings (colonoscopy, mammogram, prostate, diabetes), and most vaccines (flu, COVID, pneumococcal). The IRA expanded $0 cost-sharing for certain adult vaccines under Part D effective 2023, and capped insulin at $35/month under Part D.
Does Part B cover preventive care?
Yes — with $0 cost-sharing for most preventive services delivered by Medicare-assigned providers. Covered preventive services include the annual wellness visit, many cancer screenings (colonoscopy, mammogram, prostate, lung), cardiovascular screenings, diabetes screening and self-management training, depression screening, and most vaccines.
The annual wellness visit is NOT a full physical — it's a once-a-year appointment to update your prevention plan, screen for cognitive impairment, and review your medications. Worth doing every year.
Does Part B cover mental health?
Yes. Part B covers outpatient mental health services including individual and group therapy, psychiatric evaluation, medication management, and depression screening (annual, $0). Coverage now includes services from licensed marriage and family therapists and licensed mental health counselors as of 2024.
Part B also covers a one-time depression screening and an annual depression screening with no cost-sharing in primary care settings.
What about chiropractic, acupuncture, and physical therapy?
Part B covers limited chiropractic services (manual manipulation of the spine to correct subluxation), acupuncture for chronic low back pain only (up to 12 sessions in 90 days, with up to 8 more if improving), and outpatient physical therapy with no annual visit cap (subject to Medicare's medical-necessity rules).
Massage therapy is NOT covered. Many Medicare Advantage plans add additional alternative-medicine benefits, which is one reason some people prefer that path.
Can I have Part B and a Health Savings Account (HSA)?
No — once you enroll in Part B (or any part of Medicare), you can no longer make new HSA contributions. You can still spend down what's in your HSA tax-free for qualified medical expenses, including some Medicare costs.
If you're working past 65 and contributing to an HSA, talk to a tax advisor before you file for Social Security. Social Security retirement benefits trigger automatic Part A enrollment retroactive up to 6 months — which can require repaying HSA contributions made during that lookback.
How is Part B different from a Medicare Advantage plan?
Part B is part of Original Medicare — federal coverage that lets you see any provider that accepts Medicare nationwide, with the 20% coinsurance and no annual out-of-pocket cap. To round it out, most Original Medicare beneficiaries add a Medigap supplement plus a standalone Part D drug plan.
A Medicare Advantage plan (Part C) is a private alternative bundle. The plan provides your Part A and Part B coverage, almost always with built-in Part D drug coverage, with a network of providers and an annual out-of-pocket cap. You still pay the Part B premium ($202.90 in 2026 standard) plus any plan-specific premium. Free, unbiased help comparing the two paths is available through SHIP at or Chapter Medicare at (352) 841-0632.
Sources
Every figure and rule on this page is verified against primary sources. Last verified 2026-04-27.
- IRMAA is calculated based on the modified adjusted gross income reported on the IRS tax return from two years prior. —ssa.gov(verified 2026-04-28)
- Form SSA-44 allows beneficiaries to request a reduction in IRMAA following a documented life-changing event such as retirement, marriage, divorce, or death of a spouse. —ssa.gov(verified 2026-04-28)
- Beneficiaries collecting Social Security have their Medicare Part B premium automatically deducted from their monthly Social Security payment. —ssa.gov(verified 2026-04-28)
- Filing for Social Security retirement benefits triggers automatic Part A enrollment with up to 6 months of retroactive coverage. —ssa.gov(verified 2026-04-28)
- Medicare Part B is medical insurance covering doctor visits, outpatient care, preventive services, durable medical equipment, mental health, and ambulance services. —medicare.gov(verified 2026-04-28)
- The 2026 standard Medicare Part B monthly premium is $202.90. —cms.gov(verified 2026-04-28)
- The 2026 Medicare Part B annual deductible is $283. —cms.gov(verified 2026-04-28)
- After meeting the Part B annual deductible, beneficiaries typically pay 20% coinsurance for covered services and Medicare pays 80% of the Medicare-approved amount. —medicare.gov(verified 2026-04-28)
- Original Medicare (Parts A and B alone) has NO annual out-of-pocket spending cap. —medicare.gov(verified 2026-04-28)
- The 2026 IRMAA starting threshold for Part B and Part D premium surcharges is $109,000 modified adjusted gross income for single filers and $218,000 for joint filers. —cms.gov(verified 2026-04-28)
- Most Medicare-covered preventive services (annual wellness visit, many cancer and cardiovascular screenings, vaccines) have no patient cost-sharing under Part B when delivered by participating … —medicare.gov(verified 2026-04-28)
- Part B late-enrollment penalty is 10% added to the standard premium for each full 12 months the beneficiary was eligible but did not enroll, applied for life. —medicare.gov(verified 2026-04-28)
- For employers with 20 or more employees, the group health plan is the primary payer for Medicare-eligible employees and Medicare is secondary. —cms.gov(verified 2026-04-28)
- For employers with fewer than 20 employees, Medicare is generally the primary payer when an employee becomes Medicare-eligible at 65. —cms.gov(verified 2026-04-28)
- Medicare Part B covers acupuncture for chronic low back pain only, up to 12 sessions in 90 days, with up to 8 additional sessions if improvement is shown. —medicare.gov(verified 2026-04-28)
- Medicare-covered mental health services as of 2024 include treatment provided by licensed marriage and family therapists and licensed mental health counselors. —medicare.gov(verified 2026-04-28)
- Medicare beneficiaries cannot make new Health Savings Account (HSA) contributions once enrolled in any part of Medicare, including Part A. —irs.gov(verified 2026-04-28)
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