Medicare Part B in 2026: What You're Paying and What You Get

Medicare Part B is the piece of Original Medicare that most beneficiaries interact with constantly — every time you see a doctor, get a lab test, receive an infusion, or pick up a piece of durable medical equipment. Yet many people who've been on Medicare for years still don't fully understand what Part B covers, what it costs at different income levels, or how the rules around enrollment can permanently affect their monthly premium. In 2026, those details matter more than ever as healthcare costs continue to rise and more beneficiaries face income-based premium adjustments.

The standard Part B premium in 2026 is $185.00 per month, deducted automatically from your Social Security check if you receive benefits. That figure applies to individuals with a modified adjusted gross income (MAGI) of $106,000 or less, or married couples filing jointly with a MAGI of $212,000 or less. If your income exceeds those thresholds, you pay an Income-Related Monthly Adjustment Amount, known as IRMAA, on top of the standard premium. The IRMAA tiers in 2026 range from an additional $74.00 per month at the first income tier all the way up to an additional $443.90 per month for individuals earning above $500,000. That means the highest-income beneficiaries pay $628.90 per month for Part B alone — more than triple the standard rate. CMS determines your IRMAA based on your tax return from two years prior, so your 2026 premium is calculated using your 2024 income.

Beyond the monthly premium, Part B carries a $257 annual deductible in 2026. You pay that amount out of pocket before Medicare begins sharing costs. After the deductible, Medicare typically covers 80% of the Medicare-approved amount for covered services, leaving you responsible for the remaining 20% with no out-of-pocket cap under Original Medicare alone. That 20% coinsurance is one of the primary reasons many beneficiaries add a Medigap supplemental policy or enroll in a Medicare Advantage plan — both of which can limit exposure to that open-ended cost sharing. Without supplemental coverage, a single hospitalization or extended course of outpatient treatment can generate thousands of dollars in 20% coinsurance charges.

What does Part B actually cover? The list is broader than most people realize. On the medical side, Part B covers physician services in any setting — your primary care doctor's office, a specialist's clinic, a hospital outpatient department, or a surgery center. It covers outpatient mental health services, physical and occupational therapy, speech-language pathology, and cardiac or pulmonary rehabilitation programs. Part B also covers most diagnostic tests, X-rays, MRIs, CT scans, and lab work ordered by your physician. Crucially, Part B — not Part A — covers most chemotherapy administered in an outpatient setting, along with many other infusion therapies. Durable medical equipment such as wheelchairs, walkers, CPAP machines, and home oxygen equipment is also a Part B benefit, provided the equipment is deemed medically necessary and supplied by a Medicare-enrolled provider.

Preventive care is one of Part B's most underused benefits. Medicare covers an annual wellness visit at no cost to you — no deductible, no coinsurance — as long as your provider accepts Medicare assignment. This is different from a traditional physical exam, and many beneficiaries don't realize the distinction until they receive a bill. The wellness visit focuses on updating your health history, reviewing your medications, and creating a personalized prevention plan. Part B also covers screenings for cardiovascular disease, diabetes, certain cancers including colorectal and lung cancer, depression, and alcohol misuse — many at no cost sharing. Flu shots, pneumococcal vaccines, and hepatitis B vaccines for at-risk individuals are covered at 100% under Part B. The COVID-19 vaccine is also covered without cost sharing.

Enrollment timing for Part B is one of the most consequential decisions a new Medicare beneficiary makes, and the rules are strict. Your Initial Enrollment Period (IEP) is a seven-month window: it begins three months before the month you turn 65, includes your birthday month, and extends three months after. If you enroll during the three months before your birthday month, your coverage starts the first day of your birthday month. If you enroll during your birthday month or the three months after, coverage is delayed by one to three months. Missing your IEP without having qualifying employer-sponsored coverage triggers a late enrollment penalty — a permanent 10% increase in your Part B premium for every 12-month period you went without coverage. Someone who delays enrollment for three years, for example, would pay a 30% premium surcharge for the rest of their life.

If you're still working at 65 and covered by an employer group health plan through your own current employment (or your spouse's), you can delay Part B without penalty. The key word is "current" — COBRA coverage and retiree health coverage do not count as qualifying coverage for this purpose. When that employer coverage ends, you have an eight-month Special Enrollment Period to sign up for Part B without penalty. Many beneficiaries make the costly mistake of waiting until they lose employer coverage to contact Medicare, not realizing the SEP clock starts when the employment or coverage ends — whichever comes first — and that waiting until the General Enrollment Period (January 1 through March 31 each year) instead of using the SEP means coverage won't start until July 1 of that year.

If you believe your IRMAA surcharge is incorrect — because your income has dropped significantly since the tax year CMS used — you can appeal using Form SSA-44. Life-changing events that qualify for an IRMAA reduction include retirement, divorce, death of a spouse, loss of income-producing property, and reduction in work hours. You file the appeal with your local Social Security office and provide documentation of the income change. This is a genuinely useful option for recently retired beneficiaries who had high earned income in the reference year but are now living on Social Security and investment income at a much lower level.

For beneficiaries with limited income and resources, the Medicare Savings Programs administered by state Medicaid agencies can pay the Part B premium, deductible, and coinsurance on your behalf. The Qualified Medicare Beneficiary (QMB) program covers the most — premium, deductible, and cost sharing — for individuals with income at or below roughly 100% of the federal poverty level. The Specified Low-Income Medicare Beneficiary (SLMB) program pays the Part B premium for those with income between 100% and 120% of poverty. These programs are significantly underenrolled; millions of eligible beneficiaries are paying Part B costs they don't have to. You apply through your state Medicaid office, and eligibility is reassessed annually. If you're approved for a Medicare Savings Program, you're also automatically enrolled in the Extra Help program for Part D prescription drug costs.

Understanding Part B is not a one-time exercise. Premiums adjust annually, IRMAA thresholds are indexed to inflation, and coverage policies for specific services can change as CMS updates its National Coverage Determinations. Checking your Medicare Summary Notice — the quarterly statement showing what Part B paid on your behalf — is one of the most practical ways to catch billing errors, verify that your providers are billing correctly, and track your progress toward the annual deductible. You can also review your Part B claims in real time through your MyMedicare.gov account, which is worth setting up if you haven't already.