27.3 Medicare Part B: Medical Insurance
Key Takeaways
Part B covers physician services, outpatient care, preventive services, and durable medical equipment.
Part B requires a monthly premium and annual deductible, then typically 80/20 coinsurance.
Higher-income beneficiaries pay IRMAA premium surcharges.
Part B excludes most dental, vision, hearing, and long-term care services.
Medigap policies commonly cover Part B coinsurance and deductibles.
Late enrollment penalties apply for delayed Part B enrollment without coverage.
Medicare Part B is known as "Medical Insurance" and covers outpatient medical services, physician visits, preventive care, durable medical equipment, and many services not covered by Part A. Unlike Part A, everyone pays a monthly premium for Part B.
Part B Coverage
Physician and Outpatient Services
| Service Type | Examples |
|---|---|
| Doctor visits | Office visits, consultations |
| Outpatient surgery | Ambulatory surgical centers |
| Emergency services | Emergency room visits (outpatient) |
| Laboratory tests | Blood work, biopsies |
| Diagnostic imaging | X-rays, CT scans, MRIs |
| Outpatient therapy | Physical, occupational, speech |
Preventive Services
| Service | Coverage |
|---|---|
| Annual wellness visit | Covered 100% (no deductible or coinsurance) |
| "Welcome to Medicare" visit | One-time preventive visit within first 12 months |
| Flu shots | Covered 100% |
| Pneumonia vaccine | Covered 100% |
| COVID-19 vaccines | Covered 100% |
| Cancer screenings | Mammograms, colonoscopies, prostate exams |
| Cardiovascular screening | Cholesterol, diabetes testing |
Key Point: Most preventive services are covered at 100% with no deductible or coinsurance when performed by providers accepting Medicare assignment.
Durable Medical Equipment (DME)
| Equipment | Examples |
|---|---|
| Mobility aids | Wheelchairs, walkers, canes |
| Oxygen equipment | Oxygen tanks, concentrators |
| Hospital beds | Home hospital beds when medically necessary |
| Blood sugar monitors | For diabetics |
| Nebulizers | For respiratory conditions |
| CPAP machines | For sleep apnea |
Other Part B Covered Services
| Service | Description |
|---|---|
| Mental health services | Outpatient therapy, psychiatric visits |
| Ambulance services | When medically necessary |
| Dialysis | Outpatient kidney dialysis |
| Home health care | Intermittent skilled care |
| Limited outpatient drugs | Some drugs administered by physician |
2026 Part B Costs
Standard Part B Premium
| Category | 2026 Amount |
|---|---|
| Standard monthly premium | $202.90 |
| Annual deductible | $283 |
| Coinsurance after deductible | Generally 20% |
Income-Related Monthly Adjustment Amount (IRMAA)
| Individual Income (MAGI, 2024 tax year) | Joint Income (MAGI) | 2026 Monthly Premium |
|---|---|---|
| ≤$109,000 | ≤$218,000 | $202.90 (standard) |
| $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-$499,999 | $410,001-$749,999 | $649.20 |
| ≥$500,000 | ≥$750,000 | $689.90 |
Exam Tip: IRMAA uses income from 2 years prior. If your income has decreased significantly (retirement, divorce, death of spouse), you can request a reconsideration.
Part B Cost-Sharing
How Part B Costs Work
| Step | Description |
|---|---|
| 1. Pay monthly premium | $202.90 standard in 2026 (or higher with IRMAA) |
| 2. Pay annual deductible | First $283 of covered services (2026) |
| 3. Pay 20% coinsurance | For most covered services after deductible |
Medicare Assignment
| Status | What It Means | Your Cost |
|---|---|---|
| Accepts assignment | Provider accepts Medicare-approved amount | 20% of approved amount |
| Doesn't accept assignment | Can charge up to 15% more | Up to 20% + 15% excess |
| Opt-out provider | Patient pays entire bill | 100% (no Medicare payment) |
Key Point: Providers who accept Medicare assignment cannot charge more than the Medicare-approved amount. Non-participating providers can charge up to 15% above the approved amount (called "limiting charge").
What Part B Does NOT Cover
Excluded Services
| Service | Alternative Coverage |
|---|---|
| Dental care | Separate dental insurance |
| Vision care (routine) | Separate vision insurance |
| Hearing aids | Not covered (hearing exams may be) |
| Cosmetic surgery | Not covered |
| Custodial care | Long-term care insurance |
| Most prescription drugs | Medicare Part D |
| Care outside U.S. | Limited exceptions only |
Important Exclusions
| Exclusion | Details |
|---|---|
| Routine eye exams | For glasses prescription not covered |
| Routine foot care | Unless diabetes-related |
| Acupuncture | Except for chronic low back pain |
| Long-term care | SNF beyond Part A coverage |
Medigap and Part B
Role of Medigap (Medicare Supplement)
| Gap | How Medigap Helps |
|---|---|
| Part B deductible | Some plans cover the $283 deductible (2026) |
| 20% coinsurance | Most plans cover all or part |
| Excess charges | Some plans cover the 15% limiting charge |
| Foreign travel | Emergency care abroad |
Key Point: Original Medicare (Parts A & B) has no out-of-pocket maximum. This is why many beneficiaries purchase Medigap (Medicare Supplement) insurance to limit their cost exposure.
Key Takeaways
- Part B covers physician services, outpatient care, preventive services, and durable medical equipment.
- Part B requires a monthly premium and annual deductible, then typically 80/20 coinsurance.
- Higher-income beneficiaries pay IRMAA premium surcharges.
- Part B excludes most dental, vision, hearing, and long-term care services.
- Medigap policies commonly cover Part B coinsurance and deductibles.
- Late enrollment penalties apply for delayed Part B enrollment without coverage.
What is the standard Medicare Part B monthly premium for 2026?
$164.90
$174.70
$185.00
$202.90
Which of the following is covered at 100% under Medicare Part B with no deductible or coinsurance?
MRI for back pain
Annual wellness visit
Outpatient surgery
Durable medical equipment
A Medicare beneficiary sees a doctor who does not accept Medicare assignment. What is the maximum the doctor can charge above the Medicare-approved amount?
5%
10%
15%
25%
Sections you finish are checked off in the contents.