Medicare Part B

Medical Insurance Coverage

What is Medicare Part B?

Medicare Part B (Medical Insurance) helps cover doctors' services, outpatient care, medical supplies, and preventive services. Part B requires a monthly premium that varies based on your income.

What Part B Covers

• Doctor visits and outpatient care

• Preventive services (flu shots, screenings, annual wellness visits)

• Ambulance services

• Durable medical equipment (wheelchairs, walkers, hospital beds)

• Mental health services (outpatient)

• Limited outpatient prescription drugs

• Clinical research and second opinions

Eligibility Requirements

You can enroll in Part B if:

• You're 65 or older and a U.S. citizen or permanent resident

• You're under 65 with certain disabilities

• You have End-Stage Renal Disease (ESRD) or ALS

Note: You must have Part A to enroll in Part B, or be eligible for Part A and choose to buy Part B.

The Core Costs

For most beneficiaries, the monthly premium is deducted directly from Social Security checks.

• Standard Monthly Premium: $202.90 (an increase of $17.90 from 2025).

• Annual Deductible: $283 (an increase of $26 from 2025).

• The "20% Rule": After the deductible is met, Medicare typically pays 80% of approved medical costs; you are responsible for the remaining 20% (unless you have a Medigap or Medicare Advantage plan).

CMS has introduced several key enhancements to Part B services this year:

• Expanded Colorectal Cancer Screenings: Medicare now covers CT Colonography (virtual colonoscopy) once every 24 months for high-risk individuals (age 45+) or once every 60 months for average-risk individuals.

• Advanced Primary Care Management: A new service where Medicare pays for a care team to coordinate your health needs 24/7, including medication management and transitions between specialists.

• Blood-Based Biomarker Tests: New coverage for blood-based colorectal cancer screenings for those aged 45–85 who meet specific criteria (covered once every 3 years).

• $35 Insulin Cap: For insulin used via a Part B-covered pump, your cost is strictly capped at $35 for a one-month supply, and the Part B deductible does not apply to this medication.

Important "Hold Harmless" Note

Most beneficiaries will see a 2.8% Cost of Living Adjustment (COLA) in their Social Security checks for 2026. While the Part B premium rose, the average Social Security increase (approx. $56/month) should cover the $17.90 premium hike for most people, meaning your net take-home pay should still increase slightly.

Have Questions About Medicare Part B?

Our Medicare experts are here to help you understand your coverage options and find the right plan for your needs.