What Part B Is
If Part A is hospital insurance, Part B is medical insurance — it covers the care you get outside of an inpatient stay. That's doctor visits, outpatient procedures, lab tests, preventive screenings, mental health care, durable medical equipment, and much of the day-to-day medicine most people actually use. Unlike Part A, Part B has a standard monthly premium ($202.90 for most people in 2026, higher for high earners via IRMAA).
Part B is the workhorse of Original Medicare. Nearly everyone who enrolls in Medicare takes Part B, and delaying it without qualifying coverage triggers a lifelong penalty — a mistake we detail in what happens if you miss Medicare enrollment.
The Broad Categories Part B Covers
Part B's reach is wide. The main categories:
- Doctor and provider services — office visits, specialists, and even physician care during a hospital stay
- Outpatient care — same-day surgery, emergency department visits, and outpatient hospital services
- Preventive services — many screenings, vaccines, and the annual wellness visit at $0 (see preventive care Medicare covers at no cost)
- Lab tests, X-rays, and diagnostic imaging
- Durable medical equipment — wheelchairs, walkers, oxygen, and more
- Mental health care — therapy and psychiatry, with 2026 expansions in coverage
- Some home health and ambulance services, physical and occupational therapy, and certain drugs administered in a clinic
What You Pay Under Part B
Part B's cost structure is the reason supplements exist. After a modest annual deductible ($283 in 2026), you generally pay 20% coinsurance of the Medicare-approved amount for most covered services — and there is no annual out-of-pocket maximum. That 20% is unlimited: a major illness or surgery could mean tens of thousands out of pocket. This open-ended exposure is the single strongest argument for adding a Medicare Supplement, which covers most or all of that 20%, or choosing a Medicare Advantage plan, which replaces Original Medicare and adds an annual out-of-pocket limit (the amount varies by plan).
The premium itself is also income-adjusted. Most people pay the standard rate, but higher earners pay IRMAA surcharges on top, based on their tax return from two years prior.
What Part B Doesn't Cover
Part B has notable gaps. It generally doesn't cover prescription drugs you take at home (that's Part D), routine dental, vision, or hearing care (covered here), long-term care, or most care abroad. It also doesn't cover cosmetic procedures or services Medicare deems not medically necessary.
Because Original Medicare (Parts A and B together) still leaves the 20% coinsurance and these coverage gaps, the practical question is never 'A or B' — you generally take both — but how you fill what they leave behind. That's the comparison we run for clients at no cost.
Frequently Asked Questions
How much is Medicare Part B in 2026?
The standard Part B premium is $202.90 per month in 2026 for most people. Higher earners pay more through IRMAA surcharges, based on their income from two years earlier.
Is Part B optional?
Technically yes, but for most people it's essential. If you delay Part B without other qualifying coverage (like an active large employer's plan), you'll face a permanent late-enrollment penalty and coverage gaps.
Does Part B have an out-of-pocket maximum?
No. Original Medicare's Part B charges 20% coinsurance with no annual cap, which is why many people add a Medicare Supplement or choose Medicare Advantage (which does include an annual in-network out-of-pocket limit that varies by plan).
Does Part B cover prescription drugs?
Only drugs administered in a clinical setting (like chemotherapy infusions or certain injectables). Prescriptions you fill at a pharmacy are covered by Part D, not Part B.
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