View Series

What Medicare Part B Covers and What You’ll Pay

It helps with your costs for doctor visits, outpatient care and preventive services, but you’ll still face premiums and more

10-minute read

Article 5 of 11 in Medicare Parts

Kimberly Lankford,

Updated September 01, 2026

AARP

Reviewed by

Xavier Vaughn, MPH

En español

Updated September 01, 2026

Illustration of an older woman with white hair in a blue gown sitting on an examination table stylized as a giant Medicare Health Insurance card

Rob Dobi

Key takeaways

Part B pays for your everyday health care expenses.
But it doesn’t cover every facet of your health, so beware.
Part B has monthly premiums, other costs when you use it.
Financial aid is available for people with fewer resources.
If you have employer insurance, you can delay sign-up.

Part B is the Medicare insurance for older adults that you’ll come to rely on for your day-to-day health needs.

As one of Medicare’s four main parts — A, B, C and D — Part B covers visits to your primary care physician and specialists you may need to see, preventive screenings and vaccines and surgery at an outpatient center. The list of services it covers is extensive.

Medicare Part B complements Part A, which covers hospitalization that might come from a single event, such as an accident or major surgery. Part B goes to the hospital with you too, helping pay for your ambulance ride in an emergency and the doctors who assess your condition and treat you while you’re there.

Both parts together are known as original Medicare. Even if you decide to enroll in a Medicare Advantage plan later, you must have Part A and Part B.

What does Medicare Part B cover?

The key to Part B coverage is whether the services from your doctor or other health care providers are considered medically necessary. That includes these treatments and medical supplies:

Doctor visits in offices, outpatient and urgent-care centers and hospitals, including other health professionals such as nurse practitioners, occupational therapists, physician assistants, physical therapists, and marriage and family therapists
Acupuncture but only for treatment of chronic lower back pain
Chiropractic spinal adjustments to realign the bones in your back
Diabetes care that includes education, a prevention program, screenings and some equipment
Diagnostic imaging and recording, such as CT scans, electrocardiograms (EKGs), magnetic resonance imaging (MRIs), positron-emission tomography (PET) scans and X-rays
Drugs infused in a doctor’s office or with equipment attached to you, such as pumps that deliver chemotherapy, insulin or morphine. The pumps are also covered when they meet Medicare criteria.
Emergency room, outpatient surgery and urgent care services
Health programs, such as cardiac rehab, obesity counseling and smoking cessation
Home health care when you qualify without a prior hospitalization
Lab work, such as blood and urine tests
Medical equipment for home use, such as walkers and wheelchairs
Occupational, physical and speech therapy
Outpatient mental health services
A wellness visit every 12 months to create a plan to prevent chronic conditions, considered a Welcome to Medicare checkup during your first 12 months with Part B

A few Part B benefits may surprise you.

While Medicare generally doesn’t cover eyeglasses or contact lenses, it will pay for one pair after cataract surgery with an implanted lens. And although you usually have to foot the bill for routine oral care, exams and other dental work before some major surgery or cancer treatment may be allowed when a potential infection could interfere with your recovery.

What Medicare Part B doesn’t cover

You may already know that original Medicare doesn’t cover dental, hearing and vision. Medicare Advantage plans generally offer some of those services with a focus on prevention, such as twice-a-year teeth cleaning.

And a small share of original Medicare supplement policies, better known as Medigap, have similar benefits or discounts.

Other exclusions:

Elective cosmetic surgery, though you may be able to fix a droopy eyelid or have excess skin removed from your lower abdomen with prior authorization
Gym memberships and general fitness benefits
Medical care outside the United States unless you’re traveling through Canada to Alaska or back from another state — with a few other exceptions
Routine foot care though Part B will cover therapeutic shoes, orthotic inserts, some exams for people with diabetes and care for foot deformities such as bunions, hammer toes and heel spurs
Weight-loss surgery unless you have a body mass index (BMI) of 35 or higher

Prescription medications that you take yourself are covered through Part D, the private insurance you buy separately or often have folded into a Medicare Advantage plan.

The costs you pay for Medicare Part B

Unlike Part A, which most people get premium-free, Part B has a monthly cost whether you use it or not.

The standard premium is $202.90 in 2026, which the Medicare trustees report estimates will increase to $209.50 in 2027. You’ll pay this premium whether you’ve chosen original Medicare or Medicare Advantage.

How you pay. If you get a Social Security or Railroad Retirement Board check, your premium is deducted from your payment. If you don’t, you’ll get a bill from the Centers for Medicare and Medicaid Services (CMS) every quarter for the upcoming three months and potentially for premiums owed for previous months if coverage is retroactive, your first month is in the middle of a billing cycle or you have past-due amounts.

All taxpayers play a role. For Medicare enrollees who qualified because they’re 65, the premium represents about a quarter of the cost of Part B coverage. For those who became eligible early because of a disability, the amount is about 18.5 percent of the coverage costs, the trustees say.

The rest of the money to pay for Part B care comes from high-income surcharges, Part B late enrollment penalties and the federal budget’s general fund.

High-income surcharge. About 1 of every 12 people with Part B pay more than the standard premium because their modified adjusted gross income, as reported on their latest tax return, is above a certain threshold.

The surcharge, called an income-related monthly adjustment amount (IRMAA), sometimes surprises recent retirees because it is calculated based on modified adjusted gross income from two years ago, when they likely were working. Income from the 2024 tax return, filed in 2025, determines what’s paid in 2026.

If you retired, were laid off or had a significant reduction in income since that return was filed, you can request the charge be lowered or eliminated.

Deductible. You’ll pay an annual deductible for Part B, $283 in 2026, before most coverage begins. Medigap policies won’t reimburse that amount unless you were eligible for Medicare before 2020 and have one of two plans that covered it.

The deductible in a Medicare Advantage plan varies. Some plans have no deductible and higher out-of-pocket limits for their enrollees. Others have a deductible but a lower spending limit.

That’s because Medicare pays private insurers a monthly stipend per enrollee in their Medicare Advantage plans. If a plan spends less than that amount, it can decide to put some of the money toward lower deductibles and benefits such as dental, hearing and vision.

Coinsurance. When you use services covered under Part B, you’ll usually pay 20 percent of the Medicare-approved amount, getting billed for it after original Medicare pays its share.

Copayments. Part B in original Medicare doesn’t usually have copays, flat upfront fees, but Medicare Advantage plans do. That fee often ends up close to the same amount as coinsurance.

Penalties. If you don’t enroll in Part B during your seven-month initial enrollment period centered around your 65th-birthday month, you could be assessed a monthly late enrollment penalty for the rest of your life. You’ll avoid the fee if you or your spouse are covered under an employer-based policy that’s at least as good as Part B, but you’ll need to sign up within eight months after that insurance ends.

This penalty is calculated based on a full 12-month period, so if you didn’t sign up for Part B until 27 months after you should have, you’ll face a lifetime 20 percent penalty without the added fraction.

Spending limits. While Medicare Advantage plans don’t have standardized deductibles, the government does place a limit on what you’ll pay out of pocket, which includes copayments, coinsurance and deductibles for what would be covered under Part A and Part B but not premiums or drug costs. It can’t exceed $9,250 for in-network care or $13,900 total for covered in-network and out-of-network services in 2026.

Original Medicare has no limit on its out-of-pocket costs, though AARP is supporting a bill for a $5,000 spending cap. That’s why buying a Medigap plan from a private insurer during your six-month Medigap open enrollment period — most states limit that chance to once in a lifetime — is a good idea.

Then your original Medicare Part B costs would equal Part B premiums, plus Medigap premiums for the most popular Plan G plus the Part B deductible well under the out-of-pocket maximum for Medicare Advantage plans.

How to get help with Part B expenses

If your income and assets are limited, you may be able to get financial assistance for your Part B out-of-pocket costs.

Your state’s Medicaid agency offers four types of Medicare Savings Programs (MSPs) that can help you pay Part B premiums as well as Part A premiums if you don’t qualify for premium-free Part A plus deductibles, copayments and coinsurance.

Some states have eliminated limits on the amount of assets you can have. Others allow people with higher incomes than federal guidelines to qualify.

When to sign up for Part B

Make sure that you’re signed up for Medicare Part B during your initial enrollment period if you don’t have insurance from a company where you or your spouse work now, but many people delay Part B because of its premiums and because their employer has better coverage.

The full retirement age for people approaching 65 now is 67. Unless you’re receiving Social Security Disability Insurance (SSDI) payments, you’re eligible for Medicare before your full Social Security retirement check.

You can delay Part B without penalty if your group-plan health insurance is through a company that employs at least 20 people.

If you are insured through the Affordable Care Act (ACA) marketplace, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), a retiree health plan or Tricare military insurance, you won’t qualify for a special enrollment period when you choose to enroll.

Automatic enrollment. You’ll be enrolled automatically in Part A and Part B if you’re receiving Social Security or Railroad Retirement Board retirement or disability benefits at least four months before your 65th birthday. Your new Medicare card will come in the mail about three months before your birthday month; four if your birthday is on the first of a month.

The Puerto Rico exception. If you live in Puerto Rico, you must apply for Part B even if you’re receiving Social Security benefits. This is different from other U.S. territories, whose residents have the same rules as those in the states and the District of Columbia.

If you don’t have health insurance from an employer where you or your spouse work, you could face penalties if you don’t sign up for Part B during your initial enrollment period and may have to wait until the general enrollment period Jan. 1 to March 31 each year. If you do have insurance, you’ll be eligible for the same special enrollment period as stateside workers.

When your work stops. When insurance through your employer ends because you or your spouse retired, either of you were laid off or the company stopped offering the benefit, you become eligible for an eight-month special enrollment period to sign up for Part B without penalty.

Do you have an HSA? If your work-based insurance is a high-deductible health plan that allows you to save pretax money for your expenses, you can’t contribute to your health savings account (HSA) while enrolled in any part of Medicare. If you do, you could face IRS penalties.

You can keep your account after you stop contributing and use it to pay any future Medicare bills.

Join our fight to protect Medicare

AARP is working to keep Medicare strong. Here’s how you can help.

Sign up to become an AARP activist for the latest news and alerts on issues you care about.
Find out more about how we’re fighting for you in Congress and across the country.
See the latest AARP research on Medicare, including Millions of People Pay Medicare Late-Enrollment Penalties for Life after Missing Key Deadlines.
AARP is your fierce defender on the issues that matter to people 50-plus. Become a member or renew your membership today.

%{postComment}%

This story, originally published July 22, 2022, has been updated with a wider range of Part B benefits, what Part B doesn’t cover, how health savings accounts fit into the mix and more information about Medicare Advantage.

About the author

Kimberly Lankford is a contributing writer who covers Medicare and personal finance and now writes about insurance for The Wall Street Journal | Buy Side. She wrote about insurance, Medicare, retirement and taxes for more than 20 years at Kiplinger’s Personal Finance and has written for The Washington Post and Boston Globe. She received the personal finance Best in Business award from the Society of American Business Editors and Writers and the New York State Society of CPAs’ excellence in financial journalism award for her guide to Medicare.

About the reviewer

Xavier Vaughn, an AARP senior adviser for Medicare programs, previously worked at the National Council on Aging in Arlington, Virginia, and Missouri Connections for Health, based in Columbia, Missouri. He earned his master’s degree in public health from the University of Alabama at Birmingham.