Medicare Part B (Medical Insurance)
Physician services, outpatient care, tests, & supplies — per calendar year
Overview
Medicare Part B is Medical Insurance that covers physician services, outpatient care, diagnostic tests, & supplies on a calendar-year basis. Part B requires a monthly premium — $202.90 standard in 2026 — plus a $283 annual deductible. After the deductible, you generally pay 20% of the Medicare-approved amount.
What Medicare Part B is
Part B is the medical-insurance side of Original Medicare. Where Part A handles hospital confinement, Part B pays for the day-to-day medical care that keeps you healthy — doctor visits, preventive screenings, outpatient procedures, lab work, & medically necessary equipment you use at home.
Part B runs on a calendar-year basis. Your deductible & any progress toward it reset every January 1.
What Part B covers
Part B covers physician services & outpatient care, including:
- Doctor visits, specialist visits, & physician services during a hospital stay
- Medications administered in a provider's office
- The annual wellness visit & preventive services such as flu shots & mammograms
- Clinical laboratory services — blood & urine tests
- X-rays, MRIs, CT scans, EKGs, & other diagnostic tests
- Physical, occupational, & speech-language therapy
- Mental & behavioral health care, including counseling & substance-use treatment
- Diabetes screenings, education, & certain diabetes supplies
- Durable medical equipment for home use — oxygen, CPAP, wheelchairs, walkers
- Ambulatory surgery center services, ambulance, & emergency-room services
- Health programs like smoking cessation, obesity counseling, & cardiac or pulmonary rehab
Who is eligible
- Anyone eligible for Medicare Part A
- Retirees without qualifying employer group coverage
- People who want doctor & outpatient coverage under Original Medicare
- Anyone planning to enroll in Medicare Advantage or a Medigap policy (both require Part B)
Why someone chooses Part B
Part B is what makes Original Medicare feel complete — it turns hospital-only Part A into a full medical plan. It's also the gateway to every other Medicare option: you must be enrolled in Part B before you can join a Medicare Advantage plan or buy a Medicare Supplement (Medigap) policy.
Important benefits & limitations
- Standard 2026 monthly premium is $202.90; higher-income earners pay an IRMAA surcharge
- $283 annual deductible; after that, Medicare typically pays 80% & you pay 20% of the approved amount
- Clinical laboratory services & most preventive care are covered at 100%
- Non-participating providers may charge up to 115% of the Medicare-approved amount — those excess charges are your responsibility
- Delaying Part B without qualifying group coverage triggers a lifelong 10% late-enrollment penalty for every 12 months you were eligible but not enrolled
IRMAA — higher premiums for higher incomes
For 2026, beneficiaries whose 2024 income exceeded $109,000 (individual) or $218,000 (joint) pay an Income-Related Monthly Adjustment Amount that raises the Part B premium from $284.10 up to $689.90 depending on income bracket. Part D also has its own IRMAA, billed directly by Medicare.
Key highlights
- 2026 standard monthly premium: $202.90
- 2026 annual deductible: $283
- You pay 20% of the Medicare-approved amount after the deductible
- Clinical laboratory services covered at 100% — you pay nothing
- Most preventive services (flu shots, wellness visit, mammograms) covered at 100%
- Higher-income earners pay IRMAA on top of the standard premium
What it covers
Doctor & specialist visits
Primary care, specialists, & physician services during a hospital stay, plus medications administered in the provider's office.
Preventive care
Annual wellness visit, flu shots, mammograms, colonoscopies, diabetes screenings, obesity counseling, smoking cessation, & cardiac/pulmonary rehab.
Lab & diagnostics
Clinical labs (blood/urine), X-rays, MRIs, CT scans, EKGs, & other diagnostic tests.
Therapies
Physical, occupational, & speech-language therapy.
Mental & behavioral health
Counseling, psychiatric evaluation, & substance use treatment.
Durable medical equipment
Oxygen, CPAP, wheelchairs, walkers, & certain diabetes supplies for use at home.
Ambulance & ER services
Emergency transport, ambulatory surgery centers, & emergency room services.
2026 Part B costs — per calendar year
| Expense | Medicare covers | You pay |
|---|---|---|
| Annual deductible | Approved expenses after deductible is met | $283 annual deductible |
| Medical expenses (physician services, inpatient/outpatient, therapy, diagnostic tests) | 80% of approved amount | 20% of approved amount |
| Excess doctor charges (nonparticipating providers, up to 115% of approved amount) | 0% above approved amount | All costs above approved amount |
| Clinical laboratory services | Generally 100% of approved amount | Nothing for services |
| Home healthcare — skilled services | 100% of approved amount | Nothing |
| Home healthcare — durable medical equipment | 80% of approved amount | 20% of approved amount |
| Outpatient hospital treatment | Medicare payment based on outpatient rates | Coinsurance based on outpatient rates |
| Blood | 80% of approved amount after first 3 pints | First 3 pints + 20% of approved amount for additional pints |
A nonparticipating physician can charge up to 115% of the Medicare-approved amount (may vary by state; New York limits are lower). If a provider accepts Medicare assignment, you only pay the 20% coinsurance. The 2026 Part B deductible ($283) & standard premium ($202.90) are the official CMS figures published November 2025; higher-income beneficiaries pay more through IRMAA.
IRMAA — higher premiums for higher incomes
For 2026, beneficiaries whose 2024 income exceeded $109,000 (individual) or $218,000 (joint) pay an Income-Related Monthly Adjustment Amount that raises the Part B premium from $284.10 up to $689.90 depending on income bracket. Part D also has its own IRMAA, billed directly by Medicare.
Medicare Savings Programs may help
QMB, SLMB, & QI programs help lower-income beneficiaries pay Part B premiums and, in some cases, deductibles & coinsurance. Some Medicare Advantage plans also include a Part B 'give-back' benefit.
Frequently asked questions
Do I have to enroll in Part B?+
Not if you have qualifying group coverage through active employment. If you don't, delaying Part B triggers a lifelong late-enrollment penalty of 10% for each 12-month period you were eligible but not enrolled.
What is IRMAA?+
The Income-Related Monthly Adjustment Amount is an extra premium tacked onto Part B (and Part D) for higher earners. In 2026, IRMAA starts at incomes above $109,000 individual / $218,000 joint (based on your tax return from 2 years ago).
How does Part B pay for care?+
Medicare pays 80% of the approved amount for most services after your $283 deductible. You (or a Medigap plan) are responsible for the remaining 20%.
When are Medicare premiums due?+
All Medicare bills are due on the 25th of the month. Missing a payment adds a past-due amount to your next bill.
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