Medicare Part B: Comprehensive Guide (2026)

What is Medicare Part B insurance?

Medicare is the federal health insurance program designed primarily for people age 65 and older, as well as for those under the age of 65 living with certain challenging illnesses or disabilities.

Medicare Part B acts as your Medical Insurance. It is a core part of Medicare that covers outpatient medical services and supplies, alongside crucial preventative services that help you stay ahead of health issues. When combined with Medicare Part A (Hospital Insurance), the two are commonly referred to together as "Original Medicare."

Am I eligible for Medicare Part B?

To be eligible for Medicare Part B, you generally must be 65 or older and be a U.S. citizen or a permanent resident that has lived in the U.S. continuously for at least 5 years.

If you are eligible for Medicare Part B, you will be required to pay the standard Part B premium to stay enrolled and keep your coverage active.

In 2026, the standard Part B premium is $202.90 per month, though it's important to note that your premium may be higher depending on your income level. You will also need to meet an annual deductible of $283 before your Part B insurance begins to shoulder the costs.

If you are under the age of 65, you may also qualify for Medicare Part B if you have a qualifying disability. If you are under 65 and have been receiving Social Security disability benefits for at least 24 months, you will be automatically enrolled in Part A and B of Medicare—providing a much-needed safety net. You are also eligible if you have End-Stage Renal Disease ("ESRD") (permanent kidney failure) or Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig's disease.

Medicare part B coverage details

Medicare Part B covers medically necessary outpatient services, essential supplies, and certain preventative services designed to safeguard your well-being.

• Doctor Visits: Medicare Part B will cover your routine doctor visits and the services and supplies that are used by your doctor during outpatient care. Part B will also step in to cover emergency room and hospital visits where you are not officially admitted as an "inpatient" by a doctor (this could include overnight observations).
• Ambulance Services: Ambulance-related services, including ground ambulance transportation to a hospital or skilled nursing facility for medically necessary care, are covered by Part B. Alternative ambulance transportation, like airplanes or helicopters, may also be covered if rapid transportation is a matter of life and death. Keep in mind that Medicare will only cover ambulance services to the nearest appropriate medical facility capable of giving you the care you need.
• Durable Medical Equipment (DME): Medicare Part B also covers necessary durable medical equipment, which refers to medical equipment your doctor has prescribed for you to use safely at home. For example, DME may include blood sugar monitors and tests, crutches, patient lifts, hospital beds, walkers, wheelchairs, pumps, nebulizers, or other specialized equipment. Medicare pays for different kinds of DME in different ways, and depending on the type of equipment, you may be required to either rent or buy them.
• Mental Health Services: Emotional and psychological well-being is vital, and Medicare Part B provides coverage for outpatient mental health services. Part B covers one free depression screening a year and will also help pay for psychotherapy, family counseling, psychiatric evaluations, medication management, diagnostic tests, and certain non-self-administered drugs. (Inpatient mental health care will generally be covered under Part A.)
• Limited Prescription Drugs: Under limited circumstances and conditions, Part B will cover prescription drug costs. Coverage is typically for complex drugs you wouldn't administer yourself, like those you receive at a doctor's office or hospital outpatient setting. These drugs include injectable and infused drugs administered by a medical professional, antigens, and drugs used with your DME.
• Clinical Research: Clinical research studies (also called clinical trials) help doctors and researchers test how well different types of medical care work and whether they are safe. You may have the choice to join a clinical research study to diagnose or treat an illness. Medicare covers certain clinical research studies and may help pay for some of your costs if you decide to participate.
• Preventative Services: In most cases, you will pay nothing for preventative services if you receive them from a healthcare provider who accepts Medicare. Typical preventative services include flu shots as well as cancer, depression, HIV, diabetes, bone mass, and cardiovascular-related screenings. The full list can be found at this link: Medicare Preventive Screening Services.
  
  In addition, you are also eligible for a free "Welcome to Medicare" preventive visit within the first 12 months you have Part B, as well as a free "Annual Wellness Visit" to develop or update a personalized prevention plan based on your current health and risk factors.

What is NOT covered by Medicare Part B?

Part B insurance strictly covers medically necessary services. Unfortunately, the following services are typically excluded because Medicare classifies them as non-medically essential:

• Routine Vision, Hearing, Dental and Foot Care Costs: Routine services for vision, hearing, dental, and foot care are notoriously not covered by Original Medicare. For example, standard vision checkups, eyeglasses, hearing aids, routine dental checkups, and dentures will generally not be covered. However, if a patient requires something medically necessary—such as cataract surgery or jaw reconstruction—those specific procedures will be covered.
  
  Even so, you may be able to secure vision, hearing, and dental benefits if you choose to enroll in a Medicare Advantage (Part C) plan, which acts as a private "all-in-one" bundled alternative to Original Medicare.
• Long-Term Care: Managing aging and illness is hard enough without surprise bills. It is critical to know that Medicare will generally not cover any custodial care, which includes non-skilled personal care such as help with daily activities like getting up, dressing, eating, bathing, and using the bathroom. Medicare will only cover skilled nursing care at a facility following a "qualifying hospital stay," and if covered, it will fall under Part A.
• Home Safety: Home safety items are not covered except in very limited circumstances when deemed strictly medically necessary by a doctor. Generally, items like grab bars, stairlifts, bathtub seats, or medical emergency systems will be out-of-pocket expenses.
• Elective Cosmetic Procedures: Part B does not cover any elective cosmetic procedures as they are not considered medically necessary. Medicare will, however, cover trauma- or accident-related reconstruction. These procedures will generally be covered under Part A as most complex surgeries take place in an inpatient setting.
• Fitness & Alternative Medicines: Medicare does not pay for fitness programs or alternative medicines. However, you may be able to access some fitness benefits (like gym memberships) through a Medicare Advantage plan (Part C).

Do I need to be enrolled in Medicare Part B?

Part B is one of the most critical components of your health insurance when you rely on Medicare. Similar to Part A, there are steep, permanent Late Enrollment Penalties if you fail to enroll when you are first eligible.

If you are turning 65, it is strongly recommended that you enroll in both Medicare Part A and B during your Initial Enrollment Period to avoid any future financial penalties, particularly if any of these situations apply to you:

• You receive health insurance from your or your spouse's employer and that employer has fewer than 20 employees
• You are currently using COBRA or retiree insurance from a previous job
• You are enrolled in an individual health insurance plan such as an ACA (Obamacare) plan
• You rely on short-term insurance or have no insurance at all
• You have VA health coverage
• You have TRICARE coverage and are retired

You may safely choose to delay enrollment in Part B if you are still actively working. To do this without penalty, you must have qualifying health coverage through your (or your spouse's) current employer. You generally qualify for this deferral if the employer providing the coverage has more than 20 employees.

Part B: Late Enrollment Penalties If you didn't get Part B when you were first eligible, your monthly premium may go up 10% for each full 12-month period you could have had Part B but didn't sign up. The penalty severely increases the longer you go without Part B coverage and, in most cases, you'll be forced to pay this penalty every time you pay your premiums for as long as you have Part B.

Part B: Pre-requisite Enrollment for Medicare Advantage and Medicare Supplement

Enrollment in Part B is a strict prerequisite when applying for a Medicare Advantage (Part C) plan or a Medicare Supplement (also known as "Medigap") policy. If you want to enroll in either of these protective plans, you must first be enrolled in both Medicare Part A and Part B.

How much does Medicare Part B cost?

Outlined below are the standard costs of Medicare Part B under Original Medicare. If you choose to receive or supplement your Medicare coverage through private health insurance options such as Medicare Advantage or a Medicare Supplement plan, the out-of-pocket costs may vary in accordance with the specific policy's stated benefits.

Part B: Premiums

Everyone who enrolls in Part B must pay a premium. This is distinctly different from Part A, where many Americans are eligible to receive coverage premium-free due to their past tax contributions. Premiums for Part B are typically deducted automatically from your monthly Social Security payments. In 2026, the standard Part B premium amount is $202.90 per month.

Medicare beneficiaries who meet certain strict low-income requirements may be eligible to participate in a Medicare Savings Program (MSP), which is designed to help pay your Medicare premiums and ease financial strain. To check if you are eligible for an MSP, you can call your State Medicaid Program directly.

Premium Adjustment for Medicare Part B

If your income reported to the IRS is above a certain threshold, you may have to pay a higher Part B premium. This surcharge is known as an Income Related Monthly Adjustment Amount (IRMAA).

Medicare uses the modified adjusted gross income reported on your IRS tax return from 2 years ago, as this is the most recent reliable tax return information provided to Social Security by the IRS. For example, Social Security would use your tax returns from 2022 to determine your IRMAA surcharge in 2026. If Social Security determines that you must pay an IRMAA, they will mail you a notice called an initial determination.

In 2026, if your 2022 income was over $103,000 individually or $206,000 jointly, your Part B premium will include IRMAA and will be significantly higher than the standard Part B premium:

What if my income is no longer as high as it was 2 years ago?

A lot of things can happen in two years, and the income reported to the IRS from a couple of years ago may no longer reflect your current, perhaps more difficult, financial situation. What should you do in this situation if Social Security has unfairly determined that you need to pay an increased premium?

You have the right to request that Social Security revisit its decision if you have experienced a "life-changing event" that caused a drastic income decrease, or if you believe the income information Social Security used to determine your IRMAA was incorrect or outdated. Social Security considers any of the following situations to be valid life-changing events:

• You or your spouse stopped working or significantly reduced your working hours
• Loss of a pension
• Involuntary loss of income-producing property due to a natural disaster, disease, fraud, or other devastating circumstances
• The death of a spouse
• Marriage, divorce, or annulment
• Receipt of a settlement payment from a current or former employer due to the employer's closure or bankruptcy

To formally request a review of your premium, you will need to fill out a Medicare IRMAA Life-Changing Event (Form SSA-44) and provide documented evidence of your life-changing event, as well as your most recent tax return verifying your newly reduced income.

Part B: Out of Pocket Costs (Deductibles, Copays, Coinsurance)

In 2026, the annual deductible for Medicare Part B is $283. Once you have successfully met your deductible, Part B coverage will kick in and pay 80% of your Medicare-eligible medical services and supplies.

You will be personally responsible for the remaining 20% out of pocket. In other words, you face a 20% coinsurance obligation for the remainder of the year, which can lead to surprisingly high bills if you need extensive medical care.

Final Words on Medicare Part B

Medicare Part B covers critically necessary outpatient services such as your doctor visits, emergency room care, and certain durable medical equipment that helps maintain your quality of life. Unlike Part A, if you are enrolled in Part B Medical Insurance, you will be required to pay the standard Part B premium. The premium you pay is tied directly to your income filed with the IRS from 2 years prior. In 2026, the standard Part B premium is $202.90 and the annual deductible sits at $283. Crucially, Part B carries a 20% coinsurance obligation for all Medicare-eligible services and supplies once you reach your deductible.