Medicare Part B Guidance
Medicare Part B: Coverage, Costs, and Enrollment
Part B is the medical and outpatient portion of Original Medicare. It generally helps cover physician services, outpatient care, preventive services, certain durable medical equipment, and other medically necessary services.
Enrollment decisions may depend on employment, employer coverage, retirement timing, income, COBRA, and Social Security status. I help people in Celina, Prosper, Frisco, McKinney, and surrounding North Texas communities.
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Current annual figures
2026 Medicare Part B Quick Facts
The standard Part B premium for 2026. Higher-income beneficiaries may pay more because of IRMAA.
The 2026 Part B deductible generally must be met before standard Part B coinsurance applies.
For many covered Part B services, Medicare generally pays 80% of the Medicare-approved amount after the deductible is met.
The beneficiary is generally responsible for the remaining 20% unless other coverage helps pay it.
Income-related adjustments may increase Part B and Part D premiums.
2026 amounts are based on current CMS figures and may change in future calendar years. Coinsurance and payment rules can vary by service.
Original Medicare basics
What Is Medicare Part B?
Part B is the medical-insurance portion of Original Medicare. It helps cover many physician, outpatient, preventive, and medically necessary services, but not every expense. A monthly premium generally applies, and a deductible and coinsurance may apply. Part A, Part D, and additional coverage may still be needed.
Hospital-related coverage
Inpatient hospital care and certain qualifying skilled nursing, hospice, and home health services.
Learn About Medicare Part A →Medical and outpatient coverage
Physician services, outpatient care, preventive care, certain equipment, and other covered medical services.
Outpatient prescriptions
Private Medicare-approved plans help cover outpatient prescription drugs under plan terms.
Choose Your Coverage Approach
Compare Medicare Supplement and Medicare Advantage to see which may fit your priorities.
Compare Your Options →Coverage categories
What Medicare Part B Generally Covers
Doctors and specialists
Generally covers medically necessary physician and specialist services when Medicare requirements are met.
Outpatient care
May cover outpatient hospital services, ambulatory services, and certain procedures.
Preventive services
Some preventive services may be covered without cost sharing when Medicare requirements are met and the provider accepts assignment, while other services may have different cost-sharing rules.
Durable medical equipment
Qualifying wheelchairs, walkers, oxygen equipment, and certain diabetes supplies may be covered when properly ordered and supplied.
Mental health services
May cover outpatient mental health services when Medicare requirements are met.
Ambulance services
Certain medically necessary ambulance services may be covered; ordinary transportation generally is not.
Understanding the structure
What Can Medicare Part B Cost?
Costs may include a monthly premium, possible IRMAA, an annual deductible, coinsurance, certain outpatient copays or facility charges, excess charges where applicable, and noncovered services.
Amounts change annually. Confirm current figures at Medicare.gov or during a review.
Income-related adjustment
What Is IRMAA?
IRMAA is an income-related amount added to Part B and sometimes Part D premiums. Social Security generally uses prior-year tax-return information. Filing status and modified adjusted gross income may affect the amount.
A qualifying life-changing event may support reconsideration, including marriage, divorce or annulment, a spouse’s death, work stoppage or reduction, loss of income-producing property or pension income, or certain employer settlement changes.
Social Security—not an insurance agent—determines IRMAA. This is not tax or legal advice.
How claims are processed
How the Part B Deductible and Coinsurance Work
The deductible generally applies once per calendar year. Afterward, Medicare typically pays its approved portion, and the beneficiary or additional coverage may owe the remainder. Assignment status and service-specific rules matter; some preventive services have special rules.
The provider submits a covered service to Medicare
Medicare determines the Medicare-approved amount
After the deductible, Medicare generally pays 80% for many covered services
The beneficiary generally pays 20% unless other coverage helps
If Medicare approves $100 for a covered service after the deductible has been met, Medicare would generally pay $80 and the beneficiary would generally owe $20.
This is a simplified example. Some services, preventive care, facility charges, provider billing rules, and other circumstances may be handled differently.Provider payment rules
Does Your Doctor Accept Medicare Assignment?
Accepting Medicare patients is not always the same as accepting Medicare assignment.
Accepts Medicare assignment
The provider agrees to accept the Medicare-approved amount as full payment for covered services. The beneficiary may still owe the applicable deductible and coinsurance.
Accepts Medicare but not assignment
The provider may accept Medicare patients without agreeing to accept the Medicare-approved amount as full payment. For certain services and where allowed, the provider may charge more than the Medicare-approved amount.
Does not accept Medicare
Different payment and billing rules may apply, and the beneficiary may owe more. Confirm participation and expected charges before receiving non-emergency care.
No universal answer
Do You Need to Enroll in Part B at 65?
Consider active employment, a spouse’s active employment, employer size and coordination, retirement timing, COBRA, retiree or Marketplace coverage, VA or military-related coverage, and Special Enrollment Period eligibility.
Do not assume every type of employer, COBRA, retiree, Marketplace, VA, or other coverage allows Part B to be delayed without consequences.
Confirm with Medicare, Social Security, and the employer benefits administrator.
Current employment matters
Working Past 65 With Employer Coverage
Some people may delay Part B while covered through current employment. Employer size and coordination determine whether Medicare is primary or secondary. A spouse’s current-employment coverage may matter. Drug coverage requires a separate creditable-status review; COBRA and retiree coverage differ.
Questions to Ask Your Benefits Administrator
- Is coverage based on current employment?
- How does it coordinate with Medicare?
- Does Medicare become primary or secondary?
- Is the employer large enough for this plan to remain primary?
- Is prescription coverage creditable?
- Can my spouse remain covered?
- When should Part B begin?
- What documentation should I keep?
After active employment
Retiring or Losing Employer Coverage After 65
Qualifying current-employment coverage may create a Part B Special Enrollment Period. It generally lasts while covered and for eight months after employment or coverage ends, whichever happens first.
COBRA and retiree coverage generally are not current-employment coverage for this period. Drug timing is separate, and a person generally should not wait until COBRA ends. CMS-40B and CMS-L564 may be used in certain delayed-enrollment situations.
Delayed enrollment
What Is the Medicare Part B Late Enrollment Penalty?
A penalty may apply when someone did not enroll when first eligible and lacks a Special Enrollment Period. It may increase the monthly premium, continue while Part B is held, and generally depends on delay length.
Confirm individual circumstances and exceptions with Medicare or Social Security.
Common gaps
What Medicare Part B Does Not Fully Cover
Routine outpatient prescriptions
Most routine dental care
Most routine vision and eyeglasses
Most hearing aids and routine hearing care
Long-term custodial care
Routine personal-care services
Every outpatient or physician expense
Services not medically necessary
Deductibles and coinsurance
Part D, Medicare Supplement, Medicare Advantage, or separate insurance may address different needs; no one product necessarily covers every gap.
Alongside Original Medicare
How Medicare Supplement Insurance Relates to Part B
Many people consider Medicare Supplement insurance because it may help reduce unpredictable Part B cost sharing while allowing them to continue using Original Medicare. A Supplement may help with certain approved coinsurance and cost sharing, depending on the standardized plan selected. Plans G and N do not cover the Part B deductible for people newly eligible after the applicable federal cutoff. Plan N may include certain copays and does not cover excess charges.
A separate premium and Part D plan generally apply; underwriting may apply outside protected rights.
Explore Medicare Supplement PlansPrivate-plan alternative
How Medicare Advantage Relates to Part B
Medicare Advantage is another way to receive Part A and B benefits. The person remains enrolled in Medicare and generally continues paying the Part B premium. Networks, plan rules, costs, authorization, benefits, drug coverage, and county availability vary.
Compare Medicare Supplement and Medicare AdvantageMedigap timing
Why Your Part B Effective Date Matters for Medigap
The federal Medigap Open Enrollment Period generally begins the first month someone is 65 or older and enrolled in Part B and lasts six months. Important purchasing protections may apply. Afterward, underwriting may apply unless another protected right exists.
This period does not repeat annually and is not the Medicare Annual Enrollment Period.
Learn about Medicare Supplement plans →Enrollment pathways
When Can You Enroll in Medicare Part B?
Pathways include the Initial Enrollment Period, automatic enrollment for some Social Security beneficiaries, applying through Social Security, a Special Enrollment Period tied to qualifying current employment, the General Enrollment Period, and other exceptional periods when applicable.
See the full enrollment timeline →Practical preparation
Medicare Part B Checklist
- Confirm whether enrollment is automatic
- Review active employer or spouse coverage
- Confirm whether delay may be allowed
- Confirm the intended effective date
- Review the premium and possible IRMAA
- Confirm doctors and assignment status
- Review deductible and coinsurance
- Coordinate Part A, Part D, and additional coverage
- Save employer and Medicare documentation
- Do not cancel coverage before replacement is confirmed
“You work directly with me—before, during, and after enrollment.”
Mike SurranoLocal guidance, direct access
Medicare Part B Help Across North Texas
I spent 14 years on the insurance-carrier side. I explain enrollment, employer coverage, Part B premiums, IRMAA, cost sharing, Medicare Supplement, Medicare Advantage, Part D, underwriting, and carrier processes in plain English.
I serve Celina, Prosper, Frisco, McKinney, Little Elm, Aubrey, Anna, Melissa, Collin County, Denton County, and surrounding North Texas communities.
A straightforward process
Understand Medicare Part B in Three Steps
- 1
Review Your Situation
Discuss age, employment, coverage, retirement timing, income considerations, and current insurance.
- 2
Confirm Enrollment Timing and Costs
Review automatic enrollment, possible delay, effective date, premium, and possible IRMAA.
- 3
Coordinate the Rest of Your Coverage
Review Part A, Part D, Medicare Supplement, or Medicare Advantage.
Clear answers
Medicare Part B FAQs
Does Medicare pay 100% after I meet the Part B deductible?+
No. For many covered Part B services, after the deductible is met, Medicare generally pays 80% of the Medicare-approved amount and the beneficiary generally owes the remaining 20%, unless other coverage helps. Some services follow different cost-sharing rules.
What is a Medicare Part B excess charge?+
An excess charge may apply when a provider does not accept Medicare assignment and is permitted to charge more than the Medicare-approved amount for certain services. Federal rules generally limit the additional charge, and some states restrict or prohibit excess charges.
What is Medicare Part B?+
The medical and outpatient portion of Original Medicare.
What does Medicare Part B cover?+
Many medically necessary physician, outpatient, preventive, equipment, and related services.
Does Medicare Part B cover doctor visits?+
Generally yes when covered and medically necessary.
Does Part B cover outpatient hospital care?+
It may, under Medicare rules and applicable cost sharing.
Does Part B cover preventive services?+
Many are covered, but not every service has zero cost sharing.
Does Part B cover durable medical equipment?+
Qualifying equipment may be covered when properly ordered and supplied.
How much does Medicare Part B cost?+
A premium generally applies, plus possible deductible and cost sharing. Current amounts change annually.
What is the Medicare Part B deductible?+
An annual amount generally paid before Medicare begins paying its portion for many services.
What is Medicare Part B coinsurance?+
The beneficiary’s share of an approved covered service after applicable deductible rules.
What is IRMAA?+
An income-related adjustment added to Part B and sometimes Part D premiums.
Why is my Part B premium higher than the standard amount?+
IRMAA, late enrollment, or another determination may apply; confirm with Social Security.
Can IRMAA be appealed or reconsidered?+
A qualifying life-changing event may support reconsideration by Social Security.
Do I have to enroll in Part B at age 65?+
Not universally. Current-employment coverage and eligibility matter.
Can I delay Part B if I am still working?+
Possibly with qualifying current-employment coverage.
Does employer size affect Part B enrollment?+
It may affect whether Medicare or the employer plan pays first.
Does COBRA let me delay Medicare Part B?+
COBRA generally is not current-employment coverage for the Part B Special Enrollment Period.
What is the Part B Special Enrollment Period?+
A period that may permit enrollment during or after qualifying current-employment coverage.
What is the Part B late enrollment penalty?+
A possible premium increase after delaying without a qualifying enrollment right.
Does Part B cover prescription drugs?+
Only certain limited drugs; routine outpatient coverage generally comes through Part D.
Do I still need Part A?+
Part B does not replace Part A hospital coverage.
How can Medicare Supplement help with Part B costs?+
Depending on the plan, it may help with certain approved coinsurance and cost sharing.
Does Plan G cover the Part B deductible?+
Not for people newly eligible after the applicable federal cutoff.
How does Medicare Advantage handle Part B services?+
Under the private plan’s coverage rules, network, and cost sharing.
Why does the Part B effective date matter for Medigap?+
It may start the six-month federal Medigap Open Enrollment Period when age requirements also are met.
Do you help people outside Celina and Prosper?+
Yes. Mike serves Collin County, Denton County, and surrounding North Texas.
Is there a cost to schedule a Medicare review?+
No separate consultation fee applies. Agents generally are compensated by an insurer upon enrollment.
Are you Medicare.gov or the government?+
No. Your Insurance Coach is not connected with or endorsed by the government or federal Medicare program.
A clearer next step
Get Help Understanding Medicare Part B
Review enrollment timing, employer coverage, premiums, IRMAA, deductibles, coinsurance, Medicare Supplement, Medicare Advantage, and your next steps.
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