Medicare Part B is medical insurance that covers doctor visits, outpatient services, preventive care, and durable medical equipment. The standard premium is $185/month in 2025 and $202.90/month in 2026.
Medicare Part B is the medical insurance portion of Original Medicare. While Part A covers hospital and inpatient care, Part B covers outpatient medical services—doctor visits, lab tests, preventive screenings, and medical equipment you need outside of a hospital setting.
Understanding what Part B covers, how much it costs, and when to enroll can help you make the most of your Medicare benefits and avoid costly late enrollment penalties.
Medicare Part B covers a wide range of medically necessary outpatient services and supplies. Here's what's included:
Doctor and Outpatient Services
Doctor visits: Office visits, consultations, and second opinions
Outpatient hospital services: Surgeries, diagnostic tests, and treatments you receive without being admitted as an inpatient
Lab tests: Blood work, urinalysis, and other clinical laboratory services
Diagnostic imaging: X-rays, CT scans, MRIs, and other imaging services
Mental health services: Outpatient therapy, psychiatric services, and counseling
Physical, occupational, and speech therapy: Outpatient rehabilitation services
Preventive Services (Most at No Cost)
Medicare Part B covers many preventive services at no cost when you see a provider who accepts Medicare assignment. These include:
"Welcome to Medicare" preventive visit: One-time visit within your first 12 months of Part B coverage
Annual Wellness Visit: Yearly visit to create or update a personalized prevention plan
Vaccinations: Flu shots, COVID-19 vaccines, pneumonia shots, Hepatitis B shots
Cancer screenings: Mammograms, colonoscopies, prostate cancer screenings, lung cancer screenings, cervical and vaginal cancer screenings
Cardiovascular screenings: Tests for cholesterol, lipids, and triglycerides (every 5 years)
Diabetes screenings: Blood glucose tests for those at risk
Depression screenings: Annual screening in a primary care setting
Bone density tests: For those at risk of osteoporosis (every 2 years)
Glaucoma tests: Annual eye exam for those at high risk
HIV screening: Annual screening for those at risk, once for all Medicare beneficiaries
Hepatitis B and C screenings: For those at risk
Obesity counseling: Behavioral counseling for those with a BMI of 30 or higher
Tobacco cessation counseling: Up to 8 sessions per year for current smokers
Alcohol misuse screening and counseling: Annual screening and up to 4 counseling sessions
Medicare Diabetes Prevention Program: Behavioral counseling program for those with prediabetes
Durable Medical Equipment (DME) and Supplies
Wheelchairs and walkers: Mobility equipment prescribed by your doctor
Hospital beds: For home use when medically necessary
Oxygen equipment: Oxygen tanks, concentrators, and related supplies
Blood sugar monitors and supplies: For people with diabetes
CPAP machines: For sleep apnea treatment
Other Covered Services
Ambulance services: Emergency transportation and medically necessary non-emergency transport
Home health care: Skilled nursing, physical therapy, and other services if you're homebound
Kidney dialysis: Outpatient dialysis treatments
Chemotherapy and radiation: Cancer treatments in an outpatient setting
Certain prescription drugs: Drugs administered in a doctor's office or outpatient setting (like chemotherapy drugs, some immunosuppressants)
Chiropractic care: Limited coverage for manual manipulation of the spine to correct a subluxation
Medical nutrition therapy: For people with diabetes or kidney disease
Medicare Part B has important coverage gaps. The following services and items are generally not covered:
Inpatient hospital stays: Covered by Medicare Part A, not Part B
Most prescription drugs: Drugs you pick up at a pharmacy are covered by Medicare Part D, not Part B
Routine dental care: Cleanings, fillings, dentures, and most dental work
Routine vision care: Eye exams for glasses, eyeglasses, and contact lenses (except after cataract surgery)
Routine hearing care: Hearing exams and hearing aids
Routine foot care: Cutting or removing corns and calluses (diabetic foot care may be covered)
Cosmetic surgery: Procedures that are not medically necessary
Acupuncture: Except for chronic low back pain (limited coverage)
Long-term care: Custodial care in a nursing home or at home
Care outside the U.S.: With very limited exceptions
Tip: Medicare Advantage (Part C) plans often include dental, vision, and hearing benefits that Original Medicare doesn't cover. If these benefits are important to you, consider comparing Medicare Advantage options.
Medicare Part B has several cost components: a monthly premium, an annual deductible, and cost-sharing for covered services.
Monthly Premium
Most people pay the standard Part B premium, which the Centers set each year for Medicare & Medicaid Services (CMS):
2025 standard premium: $185.00 per month
2026 standard premium: $202.90 per month
Annual Deductible
Before Medicare starts paying its share of covered services (except for most preventive services), you must pay the annual Part B deductible:
2025 deductible: $257
2026 deductible: $283
Cost-Sharing (Coinsurance)
After you meet your deductible, Part B typically pays 80% of the Medicare-approved amount for covered services. You pay the remaining 20% as coinsurance. There is no annual out-of-pocket maximum with Original Medicare, which is why many beneficiaries add a Medigap (Medicare Supplement) plan to help cover this 20%.
Income-Related Monthly Adjustment Amount (IRMAA)
If your income is above a certain threshold, you'll pay more than the standard premium. This additional amount is called IRMAA, and it's based on your modified adjusted gross income (MAGI) from two years prior (so 2024 income determines your 2026 IRMAA).
2026 Part B Premiums by Income Level:
Individual Income (2024) | Married Filing Jointly (2024) | 2026 Part B Premium |
$109,000 or less | $218,000 or less | $202.90 |
$109,001 – $137,000 | $218,001 – $274,000 | $284.10 |
$137,001 – $171,000 | $274,001 – $342,000 | $405.80 |
$171,001 – $205,000 | $342,001 – $410,000 | $527.50 |
$205,001 – $500,000 | $410,001 – $750,000 | $649.20 |
Above $500,000 | Above $750,000 | $689.90 |
Note: If you experience a life-changing event (retirement, divorce, death of a spouse, loss of income) that significantly reduces your income, you can request that Social Security use a more recent year's income to calculate your IRMAA.
How to Pay Your Part B Premium
Social Security deduction: If you receive Social Security benefits, your Part B premium is automatically deducted from your monthly benefit check
Medicare Easy Pay: Automatic monthly deduction from your bank account
Quarterly billing: If you don't receive Social Security benefits, you'll receive a bill from CMS that you can pay by check, credit card, or through your Medicare account
When and how you enroll in Part B depends on your situation. Understanding your enrollment options helps you avoid gaps in coverage and late enrollment penalties.
Automatic Enrollment
If you're already receiving Social Security or Railroad Retirement Board benefits when you turn 65, you'll be automatically enrolled in Medicare Part A and Part B. Your Medicare card will arrive in the mail about three months before your 65th birthday.
Important: If you don't want Part B (for example, because you have employer coverage), you can decline it by following the instructions that come with your Medicare card. You can always enroll later during a valid enrollment period.
Initial Enrollment Period (IEP)
If you're not automatically enrolled, you can sign up during your Initial Enrollment Period—a 7-month window around your 65th birthday:
3 months before your 65th birthday month
Your birthday month
3 months after your birthday month
When your coverage starts depends on when you enroll during this window. Enrolling in the first three months ensures coverage begins on the first day of your birthday month.
Special Enrollment Period (SEP)
If you have health insurance through your own or your spouse's current employer (with 20 or more employees), you can delay Part B enrollment without penalty. When the employer coverage ends (or you stop working), you have an 8-month Special Enrollment Period to sign up for Part B.
Important: COBRA and retiree health benefits do not count as "coverage based on current employment." If you're on COBRA, you should enroll in Part B during your Initial Enrollment Period to avoid penalties.
General Enrollment Period (GEP)
If you missed your Initial Enrollment Period and don't qualify for a Special Enrollment Period, you can sign up during the General Enrollment Period: January 1 – March 31 each year. Coverage begins on July 1 of that year, and you may have to pay a late-enrollment penalty.
How to Enroll
You can enroll in Medicare Part B in several ways:
Online: Through your My Social Security account at ssa.gov
By phone: Call Social Security at 1-800-772-1213 (TTY: 1-800-325-0778)
In person: Visit your local Social Security office
If you don't sign up for Part B when you're first eligible, and you don't have coverage through current employment, you may have to pay a late enrollment penalty. This penalty is added to your monthly premium for as long as you have Part B—typically for the rest of your life.
How the Penalty Is Calculated
The Part B late enrollment penalty is 10% of the standard premium for each full 12-month period you could have had Part B but didn't sign up.
Example: If you delayed enrollment for three full years (36 months) without qualifying coverage:
Penalty = 30% (10% × 3 years)
2025 premium with penalty: $185 + ($185 × 30%) = $240.50/month
2026 premium with penalty: $202.90 + ($202.90 × 30%) = $263.77/month
Extra cost over 20 years: Over $14,000 in additional premiums
The penalty increases as standard premiums increase, so a 30% penalty today will cost even more in future years.
How to Avoid the Penalty
Enroll during your Initial Enrollment Period
If you have employer coverage, enroll during your 8-month Special Enrollment Period when that coverage ends
Keep documentation proving you had creditable coverage (your employer is required to provide this)
Part B's 20% coinsurance with no annual out-of-pocket maximum means your costs can add up quickly, especially if you need expensive treatments or have a chronic condition. This is where Medicare Supplement (Medigap) plans come in.
Medigap plans help pay some or all of the costs that Original Medicare doesn't cover, including the Part B coinsurance, deductibles, and excess charges. Plans like Medigap Plan G cover nearly all out-of-pocket costs after the Part B deductible.
Important: You must be enrolled in both Part A and Part B to purchase a Medigap plan. The best time to buy Medigap is during your 6-month Medigap Open Enrollment Period, which starts the first day of the month you turn 65 and have Part B. During this window, insurance companies cannot deny you coverage or charge higher premiums due to pre-existing conditions.
Medicare Part B is essential coverage for most beneficiaries, but understanding your costs, coverage options, and enrollment windows can be complex. Our licensed Medicare agents in North Carolina can help you:
Understand what Part B covers and what it doesn't
Calculate your Part B costs, including any IRMAA
Determine the right time to enroll
Explore Medigap plans to help cover the 20% coinsurance
Compare Medicare Advantage alternatives
Avoid late enrollment penalties
Contact Health Plans of NC at 1-800-797-0327 to speak with a local Medicare specialist. Our services are free, and we're here to help you make the most of your Medicare benefits.
What is the Medicare Part B premium for 2026?
The standard Medicare Part B premium for 2026 is $202.90 per month. If your income is above $109,000 (individual) or $218,000 (married filing jointly), you'll pay a higher premium due to IRMAA (Income-Related Monthly Adjustment Amount).
What does Medicare Part B cover?
Medicare Part B covers outpatient medical services, including doctor visits, lab tests, diagnostic imaging, preventive screenings, mental health services, durable medical equipment (wheelchairs, oxygen), ambulance services, home health care, and certain drugs administered in clinical settings.
How much does Medicare Part B pay for covered services?
After you meet the annual deductible ($283 in 2026), Medicare Part B pays 80% of the Medicare-approved amount for most covered services. You pay the remaining 20% as coinsurance. Most preventive services are covered at 100% with no deductible.
What is the Part B late enrollment penalty?
If you don't sign up for Part B when first eligible and don't have employer coverage, you'll pay a 10% penalty on your premium for each whole 12-month period you delay. This penalty lasts as long as you have Part B. For example, a 3-year delay results in a 30% permanent premium increase.
Can I delay Part B if I have employer coverage?
Yes, if you have health insurance through your own or your spouse's current employer (20+ employees), you can delay Part B without penalty. When that coverage ends, you have an 8-month Special Enrollment Period to sign up. COBRA and retiree coverage do not qualify—you must enroll during your Initial Enrollment Period.
Do I need Part B to get a Medigap plan?
Yes, you must be enrolled in both Medicare Part A and Part B to purchase a Medigap (Medicare Supplement) plan. The best time to buy is during your 6-month Medigap Open Enrollment Period, which begins the first day of the month you turn 65 and have Part B.