What Is Medicare Part B?
Medicare Part B is the medical-insurance portion of Original Medicare. It helps cover doctor visits, outpatient care, preventive services, durable medical equipment and other medically necessary healthcare services.
Part B works together with Medicare Part A. Part A primarily covers inpatient hospital care, while Part B covers much of the medical care you receive from doctors and other healthcare providers.
Questions about when to enroll in Medicare Part B? Call or text The DeAngelis Agency at 215-967-8828, or send us a message.
What Does Medicare Part B Cover?
Medicare Part B generally covers medically necessary services used to diagnose or treat a medical condition, along with many preventive services intended to detect or prevent illness.
Common Part B-covered services include:
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Doctor and specialist visits
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Outpatient hospital care
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Emergency-room services
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Observation stays
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Outpatient surgery
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Diagnostic tests and medical imaging
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Clinical laboratory services
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Preventive screenings and vaccines
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Mental-health and substance-use treatment
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Physical, occupational and speech therapy
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Ambulance services
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Durable medical equipment
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Certain home-health services
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Limited medications administered in a medical setting
Coverage depends on whether Medicare considers the service medically necessary and whether the provider or supplier participates in Medicare.
Doctor and Outpatient Services
Part B covers medically necessary services provided by doctors and other qualified healthcare professionals. This can include primary-care appointments, specialist consultations, outpatient procedures, second opinions and services provided by doctors during a hospital stay.
Part B also covers outpatient and observation care. Spending a night in a hospital does not automatically make you an inpatient. You can remain under observation even if you occupy a hospital bed overnight.
Observation status can affect which Medicare deductible applies and what you may owe.
Preventive Services
Medicare Part B covers numerous preventive and screening services, including:
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The one-time “Welcome to Medicare” preventive visit
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Yearly wellness visits
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Cardiovascular screenings
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Cancer screenings
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Diabetes screenings
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Bone-mass measurements
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Depression screenings
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Certain vaccines
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Tobacco-use counseling
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Obesity counseling
The “Welcome to Medicare” visit and yearly wellness visit are preventive visits. Neither is the same as a comprehensive routine physical examination.
Many preventive services are covered without a deductible or coinsurance when eligibility requirements are met and the provider accepts Medicare assignment. Additional diagnostic tests or treatments performed during the same appointment may create a separate charge.
Durable Medical Equipment
Part B may cover medically necessary durable medical equipment prescribed for use in your home.
Examples include:
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Wheelchairs
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Walkers
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Hospital beds
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Oxygen equipment
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Blood-sugar monitors
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Certain prosthetic and orthotic devices
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Continuous positive airway pressure equipment
The prescribing practitioner and equipment supplier generally must be properly enrolled in Medicare.
Limited Outpatient Prescription Drugs
Part B covers certain medications that are administered in a doctor’s office, outpatient facility or other medical setting.
Most prescriptions obtained from a pharmacy and taken at home are covered through Medicare Part D rather than Part B.
Current Medicare Part B Costs
For 2026, the principal Medicare Part B costs are:
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Standard monthly premium: $202.90
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Annual deductible: $283
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General coinsurance: Usually 20% of the Medicare-approved amount after the deductible
These amounts can change each year.
The Part B premium is normally paid every month, even when you do not receive any covered services. It is commonly deducted from Social Security or Railroad Retirement Board benefits. People who are not receiving those benefits are ordinarily billed directly.
After you satisfy the annual deductible, Medicare generally pays 80% of the approved amount for most covered services. You are responsible for the remaining 20% unless another form of coverage pays it.
Original Medicare does not place an annual out-of-pocket maximum on your Part A and Part B expenses.
Why Do Some People Pay More?
People with higher incomes may pay an additional amount known as the Income-Related Monthly Adjustment Amount, or IRMAA.
Social Security normally determines IRMAA using income reported on a federal tax return from two years earlier. Someone whose income has decreased because of retirement, marriage, divorce, the death of a spouse or another qualifying life-changing event may be able to request a new determination.
When Should You Enroll in Medicare Part B?
Your correct enrollment date depends on whether you are receiving Social Security, whether you are still working and what type of health insurance you currently have.
After helping Medicare beneficiaries since 1985, I have found that many of the most expensive Medicare mistakes involve enrollment timing rather than the coverage itself.
Automatic Enrollment
If you are already receiving Social Security or Railroad Retirement Board benefits before turning 65, you will generally be enrolled automatically in Medicare Parts A and B.
Your Medicare card should arrive before your coverage begins.
Initial Enrollment Period
If you are not receiving Social Security benefits, you generally must enroll yourself.
Your Initial Enrollment Period lasts seven months:
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Three months before the month you turn 65
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The month you turn 65
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Three months after the month you turn 65
Enrolling before your birthday month can help prevent a delay in coverage.
What If You Are Still Working?
Many people can delay Part B without a penalty when they have qualifying group health coverage based on their own or their spouse’s current employment.
However, employer size and the way the coverage coordinates with Medicare matter. For people eligible for Medicare because of age, an employer plan from a company with 20 or more employees generally pays first. Medicare generally pays first when the employer has fewer than 20 employees.
Do not assume that having an insurance card automatically makes it safe to delay Part B. Confirm how the employer plan coordinates with Medicare before making that decision.
Learn more about taking Medicare at 65 while you are still working.
Can You Enroll in Medicare Part B After Employer Coverage Ends?
When qualifying current-employment coverage ends, you generally receive an eight-month Special Enrollment Period to enroll in Medicare Part B.
That eight-month period normally begins when the employment ends or the qualifying employer coverage ends, whichever occurs first.
You should not automatically wait until the end of the eight months. Coordinating the end of employer coverage with the beginning of Part B can help prevent a gap in insurance.
COBRA and Retiree Coverage
COBRA and retiree coverage are not considered health insurance based on current employment for this Part B enrollment rule.
The eight-month Special Enrollment Period generally begins when active employment or active-employment coverage ends—not when COBRA ends.
Waiting until COBRA expires could result in a coverage gap and a Part B late-enrollment penalty.
What Is the Part B Late-Enrollment Penalty?
If you delay Part B without qualifying for a Special Enrollment Period, your monthly premium may increase by 10% for each full 12-month period that you could have enrolled but did not.
In most situations, the penalty continues for as long as you have Medicare Part B.
Someone who delayed enrollment for two full years without qualifying employer coverage could therefore pay a 20% penalty in addition to the standard monthly premium.
What Does Medicare Part B Not Cover?
Medicare Part B does not cover every healthcare service or expense.
Services generally not covered by Part B include:
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Routine physical examinations
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Most routine dental care
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Dentures
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Routine eye examinations for prescription glasses
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Most eyeglasses and contact lenses
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Hearing aids and routine hearing examinations
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Long-term custodial care
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Most prescription medications taken at home
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Massage therapy
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Most cosmetic surgery
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Personal-comfort items
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Concierge or membership fees
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Most healthcare received outside the United States
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Services that Medicare does not consider medically necessary
Exceptions can apply. For example, Medicare may cover eyeglasses following cataract surgery and certain dental services that are directly connected to covered medical treatment.
Medicare Part A vs Part B
Medicare Parts A and B work together as Original Medicare.
Medicare Part A primarily covers:
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Inpatient hospital care
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Limited skilled-nursing facility care
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Hospice care
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Certain home-health services
Medicare Part B primarily covers:
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Doctors and specialists
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Outpatient care
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Preventive services
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Diagnostic testing
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Medical equipment
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Therapy
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Ambulance services
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Certain medications administered in a medical setting
During a hospital stay, Part A may cover the hospital facility while Part B covers the doctors and other medical professionals treating you.
How Does Part B Work With a Medicare Supplement?
A Medicare Supplement, also called Medigap, helps pay certain out-of-pocket expenses left by Original Medicare.
You must generally be enrolled in both Parts A and B to purchase a Medicare Supplement policy, and you must continue paying the Part B premium.
Your six-month Medigap Open Enrollment Period begins the first month that you are both:
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Age 65 or older
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Enrolled in Medicare Part B
During this federal enrollment period, insurance companies generally cannot use your health history to deny standardized Medicare Supplement coverage or increase your premium because of medical conditions.
After the Part B deductible:
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Plan G generally covers the remaining Part B coinsurance.
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Plan N generally covers the Part B coinsurance but may leave specified office and emergency-room copayments.
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Plan N does not cover legally permitted Part B excess charges.
Pennsylvania prohibits Part B excess charges for Medicare-covered services received in Pennsylvania. However, providers who have formally opted out of Medicare are a separate matter.
Learn more about Medicare Part B excess charges.
How Does Part B Work With Medicare Advantage?
You generally must have Medicare Parts A and B to enroll in a Medicare Advantage plan, and you must continue paying your Part B premium.
Medicare Advantage plans provide your Part A and Part B benefits through a private insurance company approved by Medicare.
Each plan can establish its own:
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Provider network
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Copayments and coinsurance
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Deductibles
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Referral requirements
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Prior-authorization requirements
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Service area
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Annual out-of-pocket maximum
Some Medicare Advantage plans have a $0 additional premium, but that does not eliminate the Medicare Part B premium.
Frequently Asked Questions
Is Medicare Part B mandatory?
Part B is voluntary, but most people need it for doctor and outpatient coverage. You also generally need Part B to purchase Medicare Supplement coverage or join a Medicare Advantage plan.
Does Part B pay 100% after the deductible?
No. For most covered services, Medicare generally pays 80% of the approved amount after the deductible. You are ordinarily responsible for the remaining 20% unless supplemental coverage pays it.
Does Part B have an annual out-of-pocket maximum?
Original Medicare does not have an annual out-of-pocket maximum for Part A and Part B expenses. Medicare Advantage plans establish their own annual maximums for covered Part A and Part B services.
Does Part B cover prescription drugs?
Part B covers a limited category of medications, usually drugs administered in a doctor’s office or outpatient medical setting. Most prescriptions taken at home require Part D or other prescription coverage.
Does Part B cover routine physical examinations?
No. Part B covers the “Welcome to Medicare” preventive visit and yearly wellness visits, but neither is a comprehensive routine physical examination.
Can I delay Part B if I am still working?
Possibly. You may be able to delay Part B if you have qualifying group health insurance based on your own or your spouse’s current employment. Employer size and coordination-of-benefits rules are important.
Can I use Medicare Part B anywhere in the United States?
With Original Medicare, you can generally receive covered services from participating providers throughout the United States. Medicare Advantage plans may have provider networks and geographic service restrictions.
Related Medicare Topics
Related Local Medicare Pages
Schedule Your Medicare Consultation Today
Medicare can be confusing, but getting answers shouldn’t be. Whether you’re enrolling for the first time, reviewing your current coverage, considering a plan change, or simply looking for a second opinion, I’m happy to help you understand your options and answer your questions.
If you’d like to discuss your Medicare options, call or text The DeAngelis Agency at 215-967-8828.
There’s no pressure and no obligation—just honest guidance to help you make a confident decision.