Medicare Part B provides essential medical insurance for outpatient and preventive care. It helps millions of seniors and eligible individuals manage doctor visits, tests, and equipment without full out-of-pocket burdens. Many turn to Part B for routine health needs beyond hospital stays.
This part covers medically necessary services and a range of preventive screenings. It works alongside Part A in Original Medicare, offering broad access to providers who accept Medicare. Costs include a monthly premium and coinsurance after meeting the deductible.
In 2026, updates to premiums and deductibles reflect healthcare trends. The standard premium sits at $202.90 monthly, with the annual deductible at $283. These figures help beneficiaries budget for covered services effectively.
Overview of Medicare Part B Coverage
Medicare Part B focuses on outpatient and preventive health services. It pays for doctor consultations, diagnostic tests, and therapies when deemed medically necessary. Preventive care often comes at no cost if providers accept assignment.
Coverage includes items like durable medical equipment for daily living support. Mental health services in outpatient settings receive benefits. Limited outpatient drugs administered by professionals also qualify under specific rules.
Part B emphasizes early detection through screenings and wellness visits. It supports ongoing management of chronic conditions. Beneficiaries enjoy flexibility to choose providers nationwide.
Medically Necessary Services Covered
Part B covers doctor visits for diagnosis and treatment of illnesses. Outpatient hospital procedures and surgeries fall under this category. Therapies such as physical, occupational, and speech receive coverage when prescribed.
Diagnostic tests like X-rays, MRIs, and lab work qualify if ordered by a provider. Ambulance transportation in emergencies or specific medical transfers gets approval. Clinical research studies approved by Medicare include participant costs.
Mental health care in outpatient clinics or partial hospitalization programs benefits from Part B. Injectable drugs given in offices or clinics often receive coverage. These services require meeting the annual deductible first.
Preventive Services Under Part B
Preventive services aim to catch issues early or prevent them entirely. Annual wellness visits allow personalized health planning with no cost. Many screenings for cancer, diabetes, and heart disease come free when using participating providers.
Flu shots and other vaccines like pneumococcal receive full coverage. Cardiovascular screenings for at-risk individuals help monitor cholesterol and blood pressure. Colonoscopies and mammograms follow set schedules without coinsurance.
Key Preventive Services Covered at No Cost:
- Annual wellness visit after the first 12 months of Part B.
- Diabetes screenings twice yearly for those at risk.
- Mammograms every 12 months for women over 40.
- Colon cancer screenings starting at age 45.
These focus on maintaining health without added expenses.
Durable Medical Equipment and Supplies
Durable medical equipment includes items for home use prescribed by doctors. Wheelchairs, walkers, hospital beds, and oxygen equipment qualify under Part B. Prosthetic devices like artificial limbs and breast prostheses after mastectomy receive benefits.
Supplies such as diabetic test strips and lancets fall under coverage for managing conditions. Orthotic devices supporting body functions get approval when medically needed. Medicare requires suppliers to meet standards for reimbursement.
Beneficiaries pay 20% coinsurance after the deductible for most equipment. Rentals or purchases depend on the item type. Always confirm with suppliers that they accept Medicare assignment.
Mental Health and Other Specialized Coverage
Outpatient mental health services cover therapy sessions and counseling. Partial hospitalization programs provide intensive daytime treatment. Inpatient mental health stays primarily fall under Part A, but related outpatient follow-up uses Part B.
Chemotherapy and radiation treatments in outpatient settings receive coverage. Certain infused drugs for conditions like rheumatoid arthritis qualify. Home health aide services ordered by doctors complement care plans.
Coverage extends to some telehealth visits for convenience. Providers must follow Medicare rules for remote delivery. These options support access in rural or mobility-limited situations.
2026 Costs for Medicare Part B
The standard monthly premium for Part B in 2026 is $202.90 for most enrollees. Higher-income individuals pay income-related adjustments ranging up to $689.90. The annual deductible stands at $283, paid once per year.
After the deductible, coinsurance typically covers 20% of approved amounts. Certain services like lab tests or preventive care cost nothing. Late enrollment penalties add 10% per year delayed to the premium permanently.
Cost Breakdown for 2026:
- Standard premium: $202.90 per month.
- Annual deductible: $283.
- Coinsurance: Usually 20% after deductible.
- No out-of-pocket maximum in Original Medicare.
These figures apply nationwide with possible state variations in assistance programs.
Comparison of Part B Coverage Categories
Here’s a straightforward comparison of major coverage areas in Medicare Part B:
| Category | Examples Covered | Typical Cost to You (After Deductible) |
|---|---|---|
| Doctor & Outpatient Services | Visits, tests, therapies, ambulance | 20% coinsurance |
| Preventive Services | Wellness visits, screenings, vaccines | $0 if provider accepts assignment |
| Durable Medical Equipment | Wheelchairs, oxygen, diabetic supplies | 20% coinsurance |
This table clarifies how costs and benefits vary across common needs.
What Part B Does Not Cover
Part B excludes routine dental, vision, and hearing services. Long-term custodial care in nursing homes lacks coverage. Most prescription drugs taken at home require separate Part D.
Cosmetic procedures and experimental treatments outside approved studies remain uncovered. International travel health needs receive very limited emergency benefits. Eyeglasses and contact lenses generally do not qualify except after cataract surgery.
Medicare Advantage plans or Medigap policies often address these gaps. Separate dental or vision insurance provides targeted support. Always verify specifics with providers.
Tips for Maximizing Part B Benefits
Choose providers who accept Medicare assignment to limit extra charges. Schedule preventive visits annually to catch issues early. Keep track of the deductible to anticipate when full coverage kicks in.
Use Medicare’s online tools to check coverage for specific services. Carry your Medicare card or use the digital version for appointments. Report changes in income promptly to avoid premium surprises.
Helpful Tips:
- Ask doctors about preventive services eligibility.
- Review Explanation of Benefits statements monthly.
- Explore state assistance for premium help if income qualifies.
- Combine with Part D for fuller prescription support.
These steps reduce unexpected expenses.
Navigating Enrollment and Changes
Initial enrollment for Part B occurs around age 65 or qualifying events. Automatic signup happens for those on Social Security. Others sign up during general periods to avoid gaps.
Special enrollment protects against penalties when losing employer coverage. Annual changes allow adjustments during open enrollment. Late signups incur permanent penalties on premiums.
Contact Social Security or Medicare for personalized guidance. Online portals simplify tracking and updates. Stay current to maintain seamless access.
Conclusion
Medicare Part B delivers valuable outpatient and preventive coverage to support health maintenance. With clear benefits for doctor care, equipment, and screenings in 2026, it eases many medical expenses. Understanding inclusions, costs, and limitations helps beneficiaries use it wisely alongside other options.
FAQ
What does Medicare Part B mainly cover?
Medicare Part B covers medically necessary outpatient services like doctor visits, diagnostic tests, and therapies. It includes durable medical equipment, mental health outpatient care, and limited injectable drugs. Preventive screenings and wellness visits often cost nothing with accepting providers.
What is the 2026 monthly premium for Part B?
The standard monthly premium in 2026 is $202.90 for most beneficiaries. Higher amounts apply based on income from two years prior. Late enrollment adds a 10% penalty per year delayed to this premium permanently.
What is the Part B deductible in 2026?
The annual Part B deductible is $283 in 2026, paid once each year. After meeting it, Medicare covers 80% of approved amounts for most services. Preventive services frequently bypass this deductible entirely.
Does Part B cover preventive screenings?
Yes, many preventive services like flu shots, cancer screenings, and annual wellness visits cost $0. These require providers who accept assignment. Coverage follows recommended schedules for age and risk factors.
What durable medical equipment does Part B cover?
Part B covers prescribed items like wheelchairs, walkers, oxygen equipment, and diabetic supplies. Beneficiaries pay 20% coinsurance after the deductible. Suppliers must participate in Medicare for full reimbursement.
Does Part B cover mental health services?
Part B covers outpatient mental health care, including therapy and partial hospitalization. Coinsurance applies at 20% after the deductible. Inpatient mental health primarily uses Part A benefits.
What outpatient drugs does Part B cover?
Part B covers limited outpatient prescription drugs given by professionals, like chemotherapy or injections in offices. Self-administered drugs at home typically need Part D. Coverage depends on administration setting.
Does Part B cover ambulance services?
Part B covers ambulance transportation for medically necessary emergencies or transfers. Coverage requires specific conditions like bed confinement. Coinsurance of 20% applies after the deductible.
What is not covered by Medicare Part B?
Part B excludes routine dental, vision, hearing aids, and long-term custodial care. Most home-use prescriptions and cosmetic procedures lack coverage. Supplemental plans or Part D address many of these gaps.
How can I check if a service is covered by Part B?
Use Medicare.gov’s coverage search tool or call 1-800-MEDICARE for details. Ask providers directly about assignment and costs. Review your plan documents or Explanation of Benefits for confirmation.
Dr. Usman is a medical content reviewer with 12+ years of experience in healthcare research and patient education. He specializes in evidence-based health information, medications, and chronic health topics. His work is based on trusted medical sources and current clinical guidelines to ensure accuracy, transparency, and reliability. Content reviewed by Dr. Usman is for educational purposes and does not replace professional medical advice.