What Medicare Part B Covers and What You’ll Pay

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.