Medicare Part B: What It Covers and What It Costs

What is Medicare Part B?

In short: Medicare Part B is the part of Original Medicare that pays for doctor visits, outpatient care, preventive services and equipment like walkers. In 2026 you pay $202.90 a month, a $283 deductible, then usually 20%.

That is the whole machine. A premium every month, a deductible once a year, and a share of each bill after that. Everything else in this post is about what falls inside it, what falls outside, and what you do when your parent's care lands on the line between the two.

If you are the one handling the paperwork, a navigator can take the follow-through off your list: the calls, the referrals, the equipment that was ordered and never arrived. Navigate Care explains how that works and what it may cost on its what you will pay page.

Most people meet Part B the hard way. A letter arrives, or a bill, and nobody explained which part of Medicare it came from. You are not failing at this. The system splits one person's care across four lettered parts and does not tell you which one is holding the pen.

Part B in one picture

Part A is mostly hospital care. Part B is mostly everything that happens outside a hospital bed: the doctor's office, the specialist, the lab, the scan, the wheelchair. Part C is Medicare Advantage, a private-plan route that has to cover at least what Original Medicare covers. Part D is prescription drugs. For a longer walk through all four, see our guide to Medicare parts explained.

Medicare.gov sorts Part B into two kinds of service. The first is medically necessary care: services or supplies used to diagnose or treat a medical condition. The second is preventive care, which stops illness or catches it early.

What Part B covers

Think of Part B as the "visits and things" part. These are the groups of services that come up most for families.

Doctor and outpatient care. Visits to a doctor or specialist, outpatient care at a clinic or hospital, and the tests that go with them. If your parent walks in and walks out the same day, this is usually Part B.

Preventive services. Medicare.gov says you pay nothing for most preventive services if you get them from a provider who accepts assignment. Accepting assignment means the provider takes the Medicare-approved amount as full payment. That is a phrase worth asking about by name before an appointment.

Durable medical equipment. Part B lists durable medical equipment among its covered items, along with oxygen equipment and accessories. That is where walkers, wheelchairs and hospital beds usually sit. Ask the doctor's office what it has to send in, because a missing order is the usual reason nothing arrives. If a walker was ordered at discharge and has not come, our page on help with medical equipment goes through who to chase.

Ambulance, mental health and clinical research. All three are on Medicare.gov's Part B list. So are limited outpatient prescription drugs, which is a short list, not your parent's whole medicine cabinet. Day-to-day prescriptions are mostly Part D.

Insulin through a pump. Medicare.gov says covered insulin for a pump under durable medical equipment costs $35 or less a month, and the Part B deductible doesn't apply.

Home health. This one confuses people. Medicare.gov says home health is covered by Part A and Part B, and that you pay nothing for covered home health services. To qualify, your parent needs part-time or intermittent skilled services and has to be "homebound": normally unable to leave home, and leaving takes a lot of effort. Medical visits and short, infrequent outings don't count against that. Equipment is the exception: after the deductible you pay 20% of the Medicare-approved amount. The agency should tell you in writing, before care starts, what Medicare won't pay for. Ask for it.

What Part B does not cover

This is the section most families need, and the part nobody explains. Medicare.gov's home health page is blunt about it. Not covered: 24-hour-a-day care at home, home meal delivery, homemaker services such as shopping and cleaning that aren't part of the care plan, and custodial or personal care, like bathing or dressing, when it's the only care your parent needs.

So the helper who comes to bathe your mother every morning is not a Part B cost. Medicare does not pay for custodial care. Our guide on whether Medicare pays for help at home covers what people do instead.

Medicare.gov's list of what Original Medicare doesn't cover also includes:

• non-medical long-term care
• most dental care, such as routine cleanings, fillings, tooth extractions and dentures
• eye exams for prescription eyeglasses
• hearing aids and the exams for fitting them
• routine physical exams

The same page notes that Medicare Advantage, Medicare Cost and PACE plans may cover some extras, such as certain vision, hearing and dental services. "May" is doing real work in that sentence. Plans differ, so read your parent's plan documents rather than assume.

Is it covered? A quick check for caregivers

You won't memorise Part B. Nobody does. A short routine, run each time a service, a supply or a bill comes up, does more.

1. Is it medically necessary or preventive? If a doctor ordered it to diagnose or treat something, or it is a screening, it is in the right neighbourhood. If it is comfort, convenience or daily living help, it probably is not.
2. Does your parent have Original Medicare or Medicare Advantage? Advantage plans must cover at least what Original Medicare covers, but their rules, networks and costs can differ. Look at the card.
3. Does the provider accept assignment? Ask the office directly. The answer changes what the bill can be.
4. Has the deductible been met this year? If not, your parent pays the first part. In 2026 that is $283.
5. What will the coinsurance be? After the deductible, usually 20%.

Services families ask about, and where they land under Original Medicare

Source: Medicare.gov, what Part B covers, home health services and what Original Medicare doesn't cover

When the answer is unclear, ask the provider's billing office to check in writing before the service, and keep the answer. If it still goes wrong, the denial letter is where the next step starts. Our guides on reading a denial letter and how to appeal a Medicare denial take it from there. For Original Medicare the appeal clock is 120 days from the date on the Medicare Summary Notice. We can't tell you an appeal will succeed. We can tell you the clock is real.

What Part B costs in 2026

There are four numbers, and they arrive in a different order than most people expect. The Medicare.gov costs page gives them.

Part B costs for 2026, Original Medicare

Source: Medicare.gov, Medicare costs

The premium is the one that surprises people, because for most it comes straight out of the Social Security cheque. If your parent's deposit looks smaller than last year's, this is often why. Medicare.gov adds that the amount can change each year and may be higher depending on income. We don't give tax or financial advice, and the income brackets are set by the agencies, so check your parent's own notice.

Here is how the 20% works, using round numbers that are an illustration and not a real price. Say a covered service has a Medicare-approved amount of $1,000, and your parent has already met the deductible this year. Medicare pays the rest. Your parent pays 20%, which is $200. Twenty per cent of a big bill is still a big bill. Supplemental coverage may pick up some of it, so find out whether your parent has any.

Help paying the premium

If $202.90 a month is too much, there is help, and it is easy to miss. AARP notes that if you qualify for a Medicare Savings Program, the state pays your Part B premiums, so you aren't liable for late penalties either.

For 2026, our guide on help paying the Medicare premium taken from Social Security lists monthly income limits:

• QMB: $1,350 for a single person, $1,824 for a married couple
• SLMB: $1,616 single, $2,184 married
• QI: $1,816 single, $2,455 married
• Resource limits: $9,950 for a single person, $14,910 for a couple

Those are the site's figures for 2026 and your state may count income differently, so confirm with your State Health Insurance Assistance Program (SHIP). SHIP counselling is free, and it is the right first call for a plan or premium question. Our page on Medicare Savings Programs and Extra Help goes through how to apply.

When to sign up, and the penalty for waiting

Most people are signed up for Part B at 65, but not everyone is, and the details matter if your parent is still working, or you are helping someone who delayed.

According to AARP, the initial enrollment period begins three months before the month you turn 65 and ends three months after your birthday month. That is seven months in all. The general enrollment period runs January 1 to March 31 each year, for people who missed the first window.

Waiting can cost. The late penalty is an extra 10 percent of the standard Part B premium for each 12-month period you could have had Part B but didn't, and AARP says it lasts as long as you have Part B. There are exceptions:

• Job-based coverage: you avoid the penalty if you enroll within eight months of losing coverage based on current work.
• Medicare Savings Programs: the state pays the premium, so there is no late penalty.
• Fewer than 12 full months have passed by the end of the general enrollment period.

If your parent is still on an employer plan, or a spouse's, the rules turn on details we can't see from here. Ask Social Security or SHIP before they drop or delay anything. That is a decision for them, not a form to rush.

One date worth knowing in 2026: Open Enrollment runs October 15 to December 7, 2026. It is the window when many families look at the whole picture, and our guide to 2027 drug plans is a place to start.

What Part B means when you are the caregiver

Most Part B pages are written to the person holding the Medicare card. Yours isn't. You are the person on the phone, in the waiting room, opening the mail. Here is what changes for you.

You usually can't act alone. Medicare, and the doctor's office, will talk to your parent about your parent's claims. To talk for them, you generally need their permission on file. Medicare will only talk to you about your parent's claims once your parent has given permission. Ask the doctor's office and 1-800-MEDICARE what they need from your parent, and do it while your parent can sign.

The Medicare Summary Notice is your friend. It lists what was billed, what Medicare approved and what your parent may owe. It is not a bill. If a charge looks wrong, compare it with the notice before paying. Our guide on reading medical bills explains the difference.

Caregiving itself is not a Part B benefit. Medicare does not pay for custodial help, and nothing in Part B pays you for the hours you put in. If you need support for yourself, the caregiver programmes through your Area Agency on Aging are a different door; we describe them in What Is a Caregiver? Who Counts and Where Help Is.

The work is logistics. The tell is rarely medical. It is logistical. The doctor recommends a CPAP, a referral, a follow-up. Someone has to book it, track it and chase the supplier. That is the part Part B does not do for you, and it is where families burn out.

Where navigation fits inside Part B

Here is something many families do not know. Since January 2024, Medicare Part B has had billing codes for navigation: Community Health Integration (G0019, G0022) and Principal Illness Navigation (G0023, G0024). Navigate Care's navigators work under those benefits.

The honest limits. Medicare does not automatically cover navigation. Eligibility depends on a qualifying condition or need and a provider visit. Under Original Medicare these services carry the Part B deductible and then 20% coinsurance, and other coverage may reduce it. For many patients with supplemental coverage the cost is usually $0, and we confirm your cost before you start. The introductory call is free; provider visits and ongoing navigation are billed separately. A navigator does not treat, diagnose or give medical advice. The doctor does that.

Is this the right route, or would a private advocate or care manager suit you better? Our compare page sets out the categories. SHIP is free and is a fair first stop if your question is one plan, one bill or one denial.