What Does Medicare Part B Cover?

🔑 10 Key Takeaways: Your Part B Reality Check

Part B covers two categories: Medically necessary services and preventive services — nothing cosmetic, nothing custodial.

You never pay $0 for everything. After your $283 annual deductible in 2026, you still owe 20% coinsurance with no out-of-pocket cap.

Part B does not cover prescriptions. That’s Part D’s job — and it’s a separate plan with separate premiums.

Inpatient hospital stays are Part A territory. Part B only handles outpatient and doctor-ordered services.

Preventive screenings are genuinely free — mammograms, colonoscopies, flu shots — if your provider accepts assignment.

Part B has a $35 insulin cap for pump users, one of the most overlooked benefits in the entire program.

Dental, vision, and hearing aids are excluded under Original Medicare — a gap dating back to 1965 that still hasn’t been fixed.

Free Part B is extremely rare. Most people pay $202.90/month in 2026, and high earners pay up to $689.90.

Part C (Medicare Advantage) wraps everything together — Parts A, B, and usually D — often adding dental, vision, and hearing.

No out-of-pocket maximum exists under Original Medicare. Without Medigap or Part C, your financial exposure is theoretically unlimited.

🏥 Part B Covers Your Outpatient Life — But Only the “Medically Necessary” Parts

Medicare Part B helps cover two types of services: medically necessary services — those that meet accepted standards of medical practice to diagnose or treat your medical condition — and preventive services, which are health care to prevent illness or detect it at an early stage when treatment is likely to work best.

That distinction between “medically necessary” and “everything else” is the invisible line that determines whether Medicare writes the check or you do. Here’s what falls on the covered side:

🩺 Part B Covered Service	💡 What It Actually Means	💲 What You Pay (2026)
Doctor & specialist visits	Office visits, consultations, second opinions	20% coinsurance after $283 deductible
Outpatient hospital services	Surgery, emergency room visits, observation stays	20% coinsurance
Lab tests & diagnostics	Blood work, X-rays, MRIs, CT scans	Usually $0 for clinical lab services
Durable medical equipment	Wheelchairs, walkers, hospital beds, oxygen	20% coinsurance
Mental health services	Psychiatry, therapy, counseling, depression screening	20% coinsurance (screenings free)
Ambulance services	Emergency and some non-emergency transport	20% coinsurance
Home health services	Skilled nursing, therapy (must be homebound)	$0 for covered services
Preventive screenings	Mammograms, colonoscopies, diabetes tests	$0 if provider accepts assignment ✅
Vaccines (select)	Flu, pneumococcal, hepatitis B, COVID-19	$0 ✅
Kidney dialysis	Outpatient dialysis treatments	20% coinsurance

Part B covers physicians’ services, outpatient hospital services, certain home health services, durable medical equipment, and certain other medical and health services not covered by Medicare Part A.

The phrase “certain other medical and health services” is doing enormous heavy lifting in that official CMS definition. It sweeps in everything from outpatient physical therapy to prosthetic devices to some oral cancer drugs — but the devil is always in the specifics of whether a particular service meets the “medically necessary” threshold.

🚫 The Shockingly Long List of What Part B Refuses to Cover

This is where Medicare’s 1965 design philosophy becomes painfully obvious. When Congress established the Medicare program in 1965, it excluded coverage of certain items and services it believed were routinely needed and low in cost, including physical examinations, drugs, hearing aids, dental services, and eyeglasses.

Six decades later, hearing aids cost thousands, dental work costs thousands more, and these exclusions remain stubbornly unchanged for Original Medicare beneficiaries.

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🚫 Not Covered by Part B	😤 Why It Stings	🔧 Your Alternative
Routine dental care	Cleanings, fillings, extractions, dentures — all excluded	Medicare Advantage or private dental plan
Routine eye exams & glasses	Refractions, contacts, frames — not covered	MA plan or private vision insurance
Hearing aids & fittings	Devices and fitting exams fully excluded	MA plan or private hearing coverage
Prescription drugs	Outpatient medications not covered at all	Medicare Part D plan (separate)
Long-term custodial care	Nursing home for daily living assistance	Medicaid or long-term care insurance
Cosmetic surgery	Breast augmentation, facelifts, etc.	Self-pay
Routine foot care	Toenail trimming, callus removal	Self-pay (diabetic exceptions exist)
Care outside the U.S.	Almost never covered internationally	Medigap plans C, D, F, G, M, or N
Concierge/boutique medicine	Direct-pay physician arrangements	Not coverable under Medicare
Acupuncture (non-pain)	Limited to chronic low back pain only	Self-pay for other conditions

Medicare will not pay for 24-hour in-home care or meals delivered to you at home. It also doesn’t cover help with activities of daily living, like bathing, getting dressed, using the toilet, eating, or moving from place to place within your home.

The dental crisis is real: Traditional Medicare does not cover dental services, vision care for refraction services, corrective lenses, or low-vision devices, or hearing care for its beneficiaries. Research from the National Academies of Sciences has found that roughly half of all Medicare beneficiaries have zero dental coverage, and among those who do use dental services, average out-of-pocket spending approaches $874 per year.

💰 No, Part B Absolutely Does Not Cover 100% — Here’s What You Actually Owe

This misconception causes more financial shock among new Medicare enrollees than almost anything else. After paying your monthly premium, you still face:

The 2026 Part B cost structure:

The standard monthly premium for Medicare Part B enrollees will be $202.90 for 2026, an increase of $17.90 from $185.00 in 2025.
The annual deductible for all Medicare Part B beneficiaries will be $283 in 2026.
After meeting the deductible: you pay 20% of every Medicare-approved service with no annual out-of-pocket maximum.

That last point deserves its own alarm bell. There’s no yearly limit on what you pay out-of-pocket, unless you have supplemental coverage, like a Medicare Supplement Insurance policy, or you join a Medicare Advantage Plan.

This means a single catastrophic health event — a complicated surgery, an extended course of chemotherapy, a series of high-cost diagnostic procedures — could theoretically cost you tens of thousands of dollars in coinsurance alone under Original Medicare with Part B.

💸 2026 Part B Costs	Amount
💳 Monthly premium (standard)	$202.90
📊 Monthly premium (income $137k-$171k)	$405.80
🏦 Monthly premium (income $500k+)	$689.90
📋 Annual deductible	$283
🏥 Coinsurance after deductible	20% of Medicare-approved amounts
🛑 Annual out-of-pocket maximum	None ⚠️
💉 Preventive services	$0 (if provider accepts assignment) ✅
🩸 Clinical lab services	Typically $0

The increase in the 2026 Part B standard premium and deductible is mainly due to projected price changes and assumed utilization increases. However, due to changes finalized in the 2026 Physician Fee Schedule Final Rule, spending on skin substitutes is expected to drop by 90% without affecting patient care — a regulatory change that actually prevented the premium from rising an additional $11 per month.

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🆓 Can You Get Part B for Free? The Honest Answer Is Almost Certainly No

Unlike Part A — which is premium-free for anyone with 40+ quarters of Medicare-taxed employment — Part B always requires a monthly premium. There is no work-history exemption, no age-based waiver, and no “free” version of Part B.

However, there are limited scenarios where your premium cost is reduced or effectively covered:

Medicare Savings Programs (state-administered): If your income and resources fall below certain thresholds, your state may pay your Part B premium through programs like the Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), or Qualifying Individual (QI) programs.

Medicare Advantage Part B premium reductions: Nearly one-third of individual Medicare Advantage plans will offer some reduction in the Medicare Part B premium in 2026 as a supplemental benefit. Some plans offer reductions exceeding $100 per month — effectively making Part B significantly cheaper if you choose the right plan in the right location.

Medicaid dual eligibility: If you qualify for both Medicare and Medicaid, your state Medicaid program typically pays your Part B premium.

🏷️ Way to Reduce Part B Cost	💲 Potential Savings	📋 Who Qualifies
QMB program	100% of premium paid by state	Very low income + limited resources
SLMB program	State pays Part B premium	Income up to 120% federal poverty level
QI program	State pays Part B premium	Income up to 135% federal poverty level
MA plan with Part B giveback	Up to $100+/month reduction	Enrollees in qualifying MA plans
Medicaid dual eligibility	Full premium covered	Qualifies for both programs

🏨 Part B Does Not Cover Inpatient Hospital Stays — That’s Part A’s Entire Job

This confusion trips up a staggering number of Medicare enrollees. Here’s the clean division:

Medicare Part A covers inpatient hospital, skilled nursing facility, hospice, inpatient rehabilitation, and some home health care services. Part B covers everything that happens outside of an inpatient admission.

The tricky gray zone? Observation status. If you’re in the hospital but classified as “observation” rather than formally admitted, you’re technically an outpatient — which means Part B covers your care, not Part A. This distinction matters enormously because Part A covers skilled nursing facility stays following a qualifying inpatient stay of three or more days. Observation days don’t count toward that three-day requirement.

🏥 Service	Part A (Hospital)	Part B (Medical)
Inpatient hospital stay	✅ Covered	❌
Outpatient hospital services	❌	✅ Covered
Observation status in hospital	❌	✅ Covered (you’re “outpatient”) ⚠️
Skilled nursing facility	✅ (after 3-day inpatient)	❌
Hospice care	✅ Covered	❌
Doctor visits during hospital stay	❌	✅ Part B pays the physician
Emergency room services	❌	✅ Covered
Ambulance to hospital	❌	✅ Covered

The insider tip nobody mentions: Even during an inpatient hospital stay covered by Part A, the physicians treating you bill separately under Part B. You’re paying both sides of the equation — the Part A hospital deductible ($1,736 in 2026) and the Part B 20% coinsurance on physician services rendered during that stay.

💊 Part B Covers a Handful of Drugs — But Prescription Coverage Requires Part D

Part B does not replace a prescription drug plan. However, it does cover a narrow but important category of medications:

Drugs administered in a doctor’s office or outpatient setting (infusions, injections, chemotherapy)
Certain oral cancer drugs if they’re also available in injectable form
Immunosuppressive drugs after organ transplant
Insulin for pump users — your cost for a month’s supply of Part B-covered insulin for your pump can’t be more than $35
Drugs used with durable medical equipment (nebulizer medications, for example)
Some antigens and vaccines (flu, pneumococcal, hepatitis B, COVID-19)

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Everything else — your daily blood pressure medication, cholesterol pills, antibiotics from the pharmacy — falls under Part D territory.

The average stand-alone Part D plan total premium is projected to decrease to $34.50 in 2026, and the Part D deductible can be no more than $615 per year. In 2026, annual out-of-pocket Part D costs will increase from $2,000 to $2,100. After hitting that out-of-pocket cap, you pay nothing for covered drugs the rest of the year — a massive benefit created by the Inflation Reduction Act.

🛡️ Part C (Medicare Advantage) — The All-in-One Alternative That Fills Part B’s Gaps

Medicare Part C isn’t a separate “thing” you add on top. It’s an entirely different delivery system that replaces Original Medicare (Parts A and B) through a private insurer while being required to cover everything Original Medicare covers — plus typically offering significant extra benefits.

In 2026, 98% or more of individual Medicare Advantage plans offer some vision, dental, or hearing benefits.

🛡️ Medicare Part C (Advantage)	Key 2026 Details
📋 What it replaces	Original Medicare Parts A & B
💊 Includes prescription drugs?	89% of plans include Part D coverage
🦷 Dental coverage?	98% of plans offer some dental
👁️ Vision coverage?	99% of plans offer some vision
👂 Hearing benefits?	98% of plans offer some hearing
💲 Average monthly premium	$14.00 (down from $16.40 in 2025)
🛑 Annual out-of-pocket cap?	Yes — unlike Original Medicare ✅
📍 Network restrictions?	Yes — most plans have provider networks
🌍 Coverage outside the U.S.?	Varies by plan

The critical trade-off that nobody frames honestly enough: Medicare Advantage gives you broader benefits and an out-of-pocket cap, but it restricts which doctors and hospitals you can use. Original Medicare lets you see any provider who accepts Medicare, anywhere in the country — but it leaves you exposed to unlimited out-of-pocket costs and gaping holes in dental, vision, hearing, and drug coverage.

🩺 The Preventive Services That Cost You Absolutely Nothing

This is Part B’s genuinely excellent feature that too many seniors underutilize. You pay nothing for most preventive services if you get the services from a health care provider who accepts assignment.

The complete list of $0-cost preventive services includes:

✅ Free Preventive Service	📅 How Often Covered
Annual “Wellness” visit	Every 12 months
“Welcome to Medicare” checkup	Once (first 12 months of Part B)
Mammogram screening	Every 12 months (women 40+)
Colorectal cancer screening	Varies by method (colonoscopy every 10 years)
Cardiovascular disease screening	Every 5 years
Diabetes screening	Up to twice per year (if at risk)
Depression screening	Annually
HIV screening	Annually (at-risk individuals)
Lung cancer screening	Annually (ages 50-77, smoking history)
Bone mass measurement	Every 24 months (high-risk individuals)
Flu, pneumococcal, COVID-19, Hepatitis B shots	Per recommended schedule
Obesity behavioral therapy	Ongoing (BMI 30+)
Smoking cessation counseling	Up to 8 sessions per 12 months
Prostate cancer screening (PSA)	Every 12 months (men 50+)
Abdominal aortic aneurysm screening	Once in a lifetime (qualifying men)

The critical distinction that catches people off guard: Screening tests are free, but diagnostic tests are not. A mammogram performed for screening purposes would not require cost sharing. However, a mammogram to evaluate a lump would be considered a diagnostic test and would require cost-sharing. Same machine, same procedure, wildly different bill — depending on why the test was ordered.

📊 The Complete Medicare Alphabet Soup: How All Four Parts Fit Together

📝 Medicare Part	🏷️ What It Is	💡 What It Covers	💲 2026 Premium
Part A	Hospital Insurance	Inpatient hospital, skilled nursing, hospice, home health	$0 (most people); up to $565/mo if buying in
Part B	Medical Insurance	Outpatient care, doctors, preventive services, DME	$202.90/mo (standard)
Part C	Medicare Advantage	Replaces A & B through private insurer; often adds dental/vision/hearing/drugs	Average $14.00/mo (plus Part B premium)
Part D	Prescription Drugs	Outpatient pharmacy medications	Average $34.50/mo (standalone)

❓ Frequently Asked Questions

Q: Does Part B cover physical therapy? Yes — outpatient physical therapy, occupational therapy, and speech-language pathology services are covered under Part B. You pay 20% coinsurance after meeting the annual deductible. There are no longer hard annual therapy caps, though a review process may kick in above certain spending thresholds.

Q: Does Part B cover mental health services? Absolutely. Part B covers outpatient mental health care including individual and group psychotherapy, psychiatric evaluations, medication management, and depression screening at zero cost annually. Since recent expansions, marriage and family counselors and licensed professional counselors can also bill Medicare directly.

Q: Does Part B cover ambulance services? Yes, but only when transportation in any other vehicle would endanger your health. Non-emergency ambulance transport is covered only with advance documentation of medical necessity. You pay 20% coinsurance.

Q: Why doesn’t Part B have an out-of-pocket maximum? Original Medicare was designed in 1965 without this consumer protection, and Congress has never added one. This is one of the primary reasons approximately 90% of Original Medicare beneficiaries carry supplemental coverage — either through Medigap, employer retiree plans, or Medicaid.

Q: Does Part B cover telehealth visits? Yes. After years of expanded telehealth access during the COVID-19 pandemic, Medicare continues to cover many telehealth services under Part B. You pay the same coinsurance as an in-person visit.

Q: Is chiropractic care covered? Only partially. Part B covers manual manipulation of the spine to correct a subluxation (when one or more bones are out of position). It does not cover X-rays, massage therapy, acupuncture (except limited chronic low back pain treatment), or other supplemental chiropractic services.

Q: Does Part B cover medical equipment at home? Yes — Part B covers durable medical equipment (DME) including wheelchairs, walkers, hospital beds, oxygen equipment, nebulizers, and blood sugar monitors when prescribed by a doctor for home use. Your copays and deductibles will still apply, and Medicare will only provide coverage through suppliers who participate in the Medicare program.

Q: What’s the difference between Part B and Medigap Plan B? They share a letter but are entirely different products. Medicare Part B is the medical insurance portion of Original Medicare, while Medicare Supplement Plan B is a supplemental plan that helps fill the gap for basic costs not covered by Original Medicare Parts A and B.

Q: Are COVID-19 tests still covered under Part B? Coverage for over-the-counter COVID tests through Medicare ended, but Part B continues to cover lab-ordered COVID-19 diagnostic tests when ordered by a healthcare provider. COVID-19 vaccines remain free under Part B.

Q: What happens if my doctor doesn’t accept assignment? Providers who don’t accept assignment can charge up to 15% above the Medicare-approved amount — known as “excess charges.” You pay the 20% coinsurance plus that extra amount. In this situation, Medigap Plans F and G would cover those excess charges for you.

🧠 The Bottom Line: Part B Is Powerful but Dangerously Incomplete on Its Own

Medicare Part B is the backbone of outpatient medical coverage for 65 million Americans — and its preventive screening benefits are genuinely world-class when used properly. But the program’s 1965-era exclusions on dental, vision, hearing, and prescription drugs create coverage canyons that cost retirees thousands of dollars annually. Combined with the absence of any out-of-pocket spending cap and a permanent 20% coinsurance structure, Part B alone leaves seniors financially exposed in ways that would be unacceptable under any modern employer health plan.

Your move? Treat Part B as the foundation, not the finished building. Layer it with either a Medigap plan (for unlimited provider choice with cost protection) or a Medicare Advantage plan (for broader benefits with network trade-offs), add Part D for prescription coverage, and schedule every single free preventive screening you’re entitled to. The benefits you don’t use are the ones that cost you the most in the long run.

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