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: $257 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.
