Medicare Part B — Medical Insurance Explained for 2026
If you are approaching Medicare eligibility or trying to understand your current coverage, Medicare Part B is one of the most important components to understand. As an independent Medicare insurance broker serving clients across New York, New Jersey, and nationwide, I help seniors navigate Medicare Part B every day, completely free of charge. Here is everything you need to know.
What Is Medicare Part B?
Medicare Part B, also known as Medical Insurance, is the component of Original Medicare that covers outpatient medical services and supplies. While Medicare Part A covers inpatient hospital care, Part B covers the medical services you receive outside of a hospital — including doctor visits, specialist appointments, preventive care, and much more.
What Does Medicare Part B Cover?
Medicare Part B covers two main categories of services:
Medically Necessary Services
Services or supplies needed to diagnose or treat a medical condition that meet accepted standards of medical practice, including:
- Doctor visits — primary care physicians, specialists, and other healthcare providers
- Outpatient hospital care — services received without being admitted as an inpatient
- Ambulatory surgical center services — outpatient surgical procedures
- Emergency care — ambulance transportation, emergency room visits, and urgent care
- Mental health services — therapy, outpatient counseling, and psychiatric care
- Durable medical equipment (DME) — walkers, wheelchairs, oxygen equipment, diabetes testing supplies, and prosthetic devices
- Home health care — medically necessary part-time skilled nursing care and physical therapy at home
- Dialysis services — for beneficiaries with kidney disease
- Lab tests and X-rays — diagnostic services ordered by your doctor
Preventive Services
Medicare Part B places a strong emphasis on preventive care, helping you detect and address health issues before they become more serious. Covered preventive services include:
- Annual wellness visits
- Cardiovascular disease screenings
- Cancer screenings, including mammograms, colonoscopies, and lung cancer screenings
- Diabetes screenings and diabetes self-management training
- Bone density measurements
- Depression screenings
- Flu, pneumonia, and COVID-19 vaccines
- “Welcome to Medicare” preventive visit in your first year
How Much Does Medicare Part B Cost in 2026?
Medicare Part B is not free — most beneficiaries pay a monthly premium and meet an annual deductible before coverage kicks in:
- Standard monthly premium: $202.90 per month in 2026
- Annual deductible: $283 in 2026. After meeting the deductible, Medicare pays 80% of approved costs
- Your share: After the deductible, you pay 20% of the Medicare-approved amount for most services with no out-of-pocket maximum under Original Medicare alone
Part B IRMAA Surcharge
Higher-income beneficiaries pay more than the standard Part B premium due to the Income-Related Monthly Adjustment Amount (IRMAA). In 2026, IRMAA surcharges begin for individuals earning over $106,000 and couples earning over $212,000. If you recently retired, your income may have dropped — and you may be able to appeal your IRMAA surcharge based on your current income. Use our Medicare IRMAA Calculator to estimate your surcharge.
The 20% Gap: Why Most Seniors Need Additional Coverage
One of the most important things to understand about Medicare Part B is that it only covers 80% of approved costs — leaving you responsible for the remaining 20% with no annual out-of-pocket maximum. For seniors with significant medical needs, this 20% can add up to thousands of dollars per year.
There are two main ways to cover this gap:
- Medicare Supplement (Medigap) plans — cover some or all of the 20% coinsurance, giving you predictable out-of-pocket costs and freedom to see any Medicare-accepting doctor nationwide
- Medicare Advantage plans — replace Original Medicare through a private carrier with network restrictions, but often lower or $0 monthly premiums and an annual out-of-pocket maximum
When to Enroll in Medicare Part B
Most people enroll in Part B during their Initial Enrollment Period (IEP) — a 7-month window beginning 3 months before the month you turn 65, including your birthday month, and ending 3 months after. Use our Medicare Enrollment Period Calculator to find your specific dates.
If you delay Part B enrollment without having qualifying employer coverage, you will face a permanent late enrollment penalty — your premium increases by 10% for each full 12-month period you were eligible but did not enroll. Use our Part B Late Enrollment Penalty Calculator to estimate your penalty.
Frequently Asked Questions — Medicare Part B
Do I have to enroll in Medicare Part B?
Part B enrollment is optional, but most people should enroll when first eligible to avoid late enrollment penalties. If you have qualifying employer coverage through an active employer, you may be able to delay Part B without penalty.
Does Medicare Part B cover prescription drugs?
No — Part B does not cover most prescription drugs. You need a separate Medicare Part D plan for prescription drug coverage, or a Medicare Advantage plan that includes drug coverage.
Does Medicare Part B cover dental, vision, and hearing?
Original Medicare Part B does not cover routine dental care, routine vision exams, or hearing aids. Some Medicare Advantage plans offer these benefits as extras.
What is the difference between Medicare Part A and Part B?
Medicare Part A covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health care. Medicare Part B covers outpatient medical services, doctor visits, preventive care, and durable medical equipment. Together, Parts A and B make up Original Medicare.
Get Your Free Medicare Part B Consultation
Understanding Medicare Part B is just the beginning; the bigger question is how to cover the 20% that Part B leaves behind. As an independent Medicare broker, I help you compare all available options — Medicare Supplement plans, Medicare Advantage plans, and Part D drug coverage to find the combination that best fits your health needs and budget. My services are completely free of charge.
I serve clients across New York, New Jersey, and nationwide — by phone, video, or in person.
📞 Contact Craig Smith Insurance Group today at (917) 740-1895 for your free Medicare consultation. No pressure, no obligation — just straightforward guidance from an independent broker with over 25 years of experience in financial services.
