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Medicare Part B Coverage, Costs, and Benefits
Medicare Part B is a key part of your healthcare coverage—helping pay for doctor visits, outpatient care, and preventive services—but it doesn’t cover everything. In most cases, you’re still responsible for about 20% coinsurance with no cap on what you could spend out of pocket. SelectQuote can help you compare plans for additional coverage that help fill these gaps.
What is Medicare Part B?
Medicare Part B is the portion of Medicare that covers outpatient medical care, including doctor visits, preventive services, lab tests, durable medical equipment, and some home health services. It helps pay for the care you receive outside the hospital and works alongside Part A to provide more complete health coverage.
Who is eligible to receive Medicare Part B coverage?
If you have Medicare Eligibility for premium-free Medicare Part A, then you are also eligible for Medicare Part B as long as you enroll and pay your monthly premium on time.
If you are not eligible for premium-free Part A, you may still qualify for Part B if:
You’re 65 or older and are a U.S. citizen or a permanent resident lawfully residing in the U.S. for at least five consecutive years.
You are younger than 65 with a qualifying disability, including end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS)—also known as Lou Gehrig’s disease—in which case you will be automatically enrolled in Medicare Part B.
You are younger than 65 and receive Social Security or Railroad Retirement Board (RRB) disability benefits, in which case you will be automatically enrolled in Medicare Part A and Part B.
What does Medicare Part B cover?
Medicare Part B covers the following:
Preventive care and tests
Medical services and supplies to treat a health condition
Ambulance services
Second opinion prior to surgery
Durable medical equipment, such as a wheelchair or walker
Certain outpatient prescription drugs
Mental health treatment (in- and outpatient, as well as partial hospitalization)
Limited rehabilitation services, like physical therapy, when ordered by your doctor
Limited home health care when ordered by your doctor
A free one-time preventive visit health assessment, which can include flu and hepatitis shots, cardiovascular screenings, cancer screenings, diabetes screenings, and more
What is NOT covered by Medicare Part B?
Medicare Part B does not cover:
Prescription drugs (most retail medications)
Routine dental care
Vision care (like eye exams for glasses)
Hearing services (including hearing aids)
Out-of-network care outside the U.S., in most cases
Because of these coverage gaps, people may choose to enroll in additional coverage. Options like Medicare Advantage (Part C) or a standalone Part D prescription drug plan can help cover services and benefits that Part B does not include. A licensed SelectQuote agent can help you compare plans and find coverage that fits your needs, so you’re confident in your plan.
What does Medicare Part B cost in 2026?
For most beneficiaries, the standard Medicare Part B monthly premium is $202.90 in 2026. Before Medicare begins paying its share for covered services, you must also meet an annual deductible of $283.
The 20% Coinsurance Gap
After you meet the $283 deductible, you’re typically responsible for 20% of the cost for most Medicare-approved services, with no annual out-of-pocket maximum. Because of this ongoing cost exposure, many people explore Medicare Supplement or Medicare Advantage plans to help cover that 20% gap—something a SelectQuote insurance agent can help you compare based on your needs.
Do high-income earners pay more for Medicare Part B? (IRMAA)
If your income exceeds a certain amount, you might pay a higher premium known as the Income-Related Adjusted Amount (IRMAA). These amounts may change with each calendar year. Below are the payment amounts based on your tax return information:
Yearly Income in 2024 (Individual Return) | Yearly Income in 2024 (Joint Return) | 2026 Total Monthly Part B Premium |
$109,000 or less | $218,000 or less | $202.90 (Standard) |
$109,001 to $137,000 | $218,001 to $274,000 | $284.10 |
$137,001 to $171,000 | $274,001 to $342,000 | $405.80 |
$171,001 to $205,000 | $342,001 to $410,000 | $527.50 |
$205,001 to $499,999 | $410,001 to $749,999 | $649.20 |
$500,000 or above | $750,000 or above | $689.90 |
Source: https://www.medicare.gov/
How to Fill Your Medicare Part B Coverage Gaps
There are two common ways to help protect yourself from these out-of-pocket costs:
Medicare Supplement (Medigap): These plans work alongside Original Medicare and are designed to help pay the remaining 20% coinsurance, along with other out-of-pocket expenses like deductibles and copayments. They can provide more predictable healthcare costs and broader provider access.
Medicare Advantage (Part C): These plans are offered by private insurers as an alternative to Original Medicare. They bundle Part A and Part B coverage and often include prescription drug coverage, with set copays and an annual out-of-pocket maximum to help limit your financial risk.
Medicare Part B Enrollment Guidelines
If you already collect Social Security benefits, you’ll be automatically enrolled for Medicare Part B. If you’re over 65 (or turning 65 in the next three months), you need to sign up for Part B (and also Part A)—you will not be automatically enrolled.
Enrollment Periods
Initial Enrollment Period (IEP)
When you first become eligible for Original Medicare, you have a seven-month Initial Enrollment Period to sign up for Part A that includes the three months prior to your 65th birthday month, your birthday month, and the three months following your birthday month.
It’s important to know that if you wait until the month you turn 65 or the three months following, your Part A coverage will be delayed, causing a gap in your coverage. In many cases, if you don’t sign up for Part A when you’re first eligible, you’ll have to pay a late enrollment penalty.
> Learn More About IEP
General Enrollment Period (GEP)
General enrollment for Medicare Part A (and Medicare Part B) takes place January 1 to March 31 each year. During this period, you can sign up if:
You didn’t sign up when you were first eligible
(you may have to pay a late enrollment penalty, resulting in a higher premium)
You aren’t eligible for a Special Enrollment period
Special Enrollment Period (SEP)
After your Initial Enrollment Period ends, you may be able to sign up during a SEP, and you typically won’t have to pay a late enrollment penalty if you do. You may be eligible if:
You’re covered under a group health plan based on current employment and have a SEP to sign up for Part A and/or Part B anytime, as long as:
You or your spouse (or family member if you’re disabled) is working
You’re covered by a group health plan through the employer or union based on that work
You have an eight-month SEP to sign up for Part A and/or Part B that starts at one of these times (whichever happens first):
The month after the employment ends
The month after the group health plan insurance based on current employment ends
You may qualify for a Special Enrollment Period for Part A and Part B if you’re a volunteer serving in a foreign country
Explore Your Medicare Plan Options with SelectQuote
With over 40 years of experience and over 60 million people served, we’re proud to be a trusted partner in your Medicare journey. In just minutes, SelectQuote’s licensed insurance agents can compare Medicare plan options that may be available in your area. It’s free, and there’s no obligation to enroll.
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