Original Medicare guide
Medicare Part B Coverage and Costs
Understand Part B physician, outpatient, preventive, home health and equipment coverage, along with the 2026 premium, deductible and ordinary coinsurance.
Covered services
What falls under Part B?
Doctors and outpatient care
Part B can cover office visits, specialists, outpatient hospital services, surgery, laboratory tests, imaging, therapy and other medically necessary services. For physical, occupational and speech-language pathology rules, see Medicare Therapy Coverage.
Preventive services
Defined screenings, vaccines and wellness visits can be covered with no cost when frequency, eligibility and assignment requirements are met.
Equipment and supplies
Medically necessary durable medical equipment can be covered when prescribed and obtained through a supplier that meets Medicare requirements.
Other Part B benefits
Ambulance services, certain injectable or infused drugs, mental health care, limited chiropractic care and qualifying home health services can fall under Part B. For ground, air and non-emergency transport rules, see Medicare Ambulance Coverage. For therapy, psychiatry, telehealth and higher-intensity behavioral health programs, see Medicare Mental Health Coverage.
Kidney-failure coverage has additional rules that do not belong in a general Part B overview. See Medicare and ESRD for outpatient dialysis, transplant services, ESRD drugs and post-transplant immunosuppressive coverage. Diabetes is another common case where Part B and Part D divide coverage; see Medicare Diabetes Coverage for CGMs, pumps, insulin and testing supplies.
2026 costs
Premium, deductible and coinsurance
The standard Part B premium is $202.90 per month in 2026, although people with higher modified adjusted gross income can pay an income-related adjustment. The annual deductible is $283. After that deductible, a common share is 20% of the Medicare-approved amount for covered services.
Twenty percent has no built-in ceiling. A percentage can be significant for outpatient surgery, chemotherapy, durable equipment or repeated therapy. Original Medicare itself has no annual out-of-pocket maximum.
Provider access and billing
What Does “Accepts Medicare” Mean?
Ask about both the provider’s Medicare billing status and your exact coverage. Accepting Original Medicare does not establish participation in a Medicare Advantage network.
| What the office says | What it means for you |
|---|---|
| Participating / accepts assignment | The provider accepts the Medicare-approved amount for covered services. Your applicable deductible and coinsurance still apply. |
| Non-participating | The provider may accept assignment for individual services. Otherwise, upfront payment and a limited additional charge may apply. Ask about this specific service before care. |
| Opted out / private contract | This is different from non-participating status. Medicare generally does not pay for privately contracted care from an opt-out provider. Ask Medicare about emergency exceptions. |
| Concierge / membership practice | Medicare does not cover the membership fee. Ask what it buys and how covered visits are billed. A provider accepting assignment cannot use a membership fee to add charges for Medicare-covered services. |
| Accepts your Medicare Advantage plan | Confirm the exact plan, clinician, office location and service with both the office and the plan. Ask whether the provider is in network, taking new patients and subject to a referral requirement. |
When you call: give the exact name on your insurance card, identify the office and service, and ask about assignment or network status, new-patient availability and any separate membership fee. Keep the date and the name of the person who confirmed the details.
Use the provider-directory links to start checking. If your doctor has left your plan, follow the provider-loss checklist.
Official guidance: assignment and opting out, concierge fees, and Medicare Advantage HMO networks.
Preventive nuance
No-cost preventive care can produce diagnostic charges
A covered preventive service can have no deductible or coinsurance when the provider accepts assignment. If a symptom is evaluated, an abnormal result is investigated or another service is performed, the additional work may be billed as diagnostic care with ordinary cost sharing.
When coverage is uncertain
Ask about an Advance Beneficiary Notice
In Original Medicare, a provider may give an Advance Beneficiary Notice of Noncoverage when it believes Medicare may not pay for an item or service. Read the reason, the estimated cost and the options before signing. An ABN is a warning, not Medicare’s final decision. A claim generally must be submitted before the ordinary appeal process can begin.
Frequently asked questions
Medicare Part B Questions
Is the Part B premium the same for everyone?
No. $202.90 is the 2026 standard premium. Some people pay more because of an income-related monthly adjustment, and certain beneficiaries can pay a different amount for other reasons.
Does Part B cover 100% after the deductible?
Usually not. Many covered services have 20% coinsurance after the deductible, although some preventive services have no cost when all requirements are met.
Does Part B cover prescriptions?
It covers certain drugs administered by a clinician or used with covered equipment, but broad retail outpatient prescriptions are generally handled by Part D.
Does Part B cover routine physicals?
Medicare covers the Welcome to Medicare preventive visit and yearly wellness visits under defined rules. Those visits are not comprehensive routine physical examinations.
More Medicare guidance
Related Articles
Primary references
Official Sources
- Medicare.gov: Part B
- CMS: 2026 Parts A and B premiums and deductibles
- Medicare.gov: How assignment affects costs
- Medicare.gov: Your protections and ABNs
Reviewed against official sources on August 22, 2026. Medicare and state program rules can change; verify current requirements before acting.
Independent Medicare guidance
Make the Next Decision With the Actual Details in Front of You
Benjamin Thompson can help compare the Medicare insurance options represented by Thompson Medicare Brokerage using your doctors, prescriptions, coverage priorities and budget.
Thompson Medicare Brokerage is not connected with or endorsed by the U.S. government or the federal Medicare program. This page provides general educational information. Coverage, costs, eligibility, networks, formularies and enrollment rights depend on individual facts, location, plan and coverage year. Thompson Medicare Brokerage does not offer every plan available in every area; Medicare.gov, 1-800-MEDICARE and SHIP can provide information about all available options.