Medicare Part B
Medicare Part B is the medical insurance half of Original Medicare, covering physician services, outpatient care, preventive services, and durable medical equipment. It carries a monthly premium ($202.90 standard in 2026) and an annual deductible ($283 in 2026), after which Medicare pays 80 percent of the approved amount and the patient owes 20 percent.
- 2026 standard premium
- $202.90/month
- 2026 annual deductible
- $283
- Coinsurance after deductible
- 20% of approved amount
- Payment basis
- Medicare Physician Fee Schedule
What does Medicare Part B cover?
Part B is the medical insurance component of Original Medicare. It pays for medically necessary physician services, outpatient hospital care, clinical lab, imaging, durable medical equipment (DME), ambulance, and a growing list of preventive services delivered at no cost sharing, such as the annual wellness visit. Where Part A covers the facility, Part B covers the professional work and outpatient encounters.
Enrollment is not automatic for everyone. People who delay Part B without qualifying coverage face a lifelong late-enrollment penalty, which is a common source of patient confusion at registration.
What does Part B cost in 2026?
Part B has both a premium and cost sharing at the point of service:
| 2026 cost | Amount |
|---|---|
| Standard monthly premium | $202.90 |
| Annual deductible | $283 |
| Coinsurance after deductible | 20% of approved amount |
| Higher-income premium (IRMAA) | Added surcharge by income tier |
The 2026 premium rose $17.90 and the deductible rose $26 over 2025. Higher earners pay an income-related monthly adjustment amount on top of the standard premium.
How does Part B pay providers?
Part B pays physicians and suppliers from the Medicare Physician Fee Schedule. Each service's allowed amount is built from relative value units multiplied by the annual conversion factor and adjusted for geography. See our fee schedule entry for how the allowed amount is derived and why it differs from billed charges.
Assignment matters: a provider who accepts assignment agrees to the fee-schedule amount as payment in full and collects only the 20 percent coinsurance and any unmet deductible from the patient.
What trips up Part B billing?
Example: a clinic bills the annual wellness visit but appends a problem-focused E/M for a diabetes recheck at the same encounter. Without a modifier and separate documentation, the payer bundles them and the practice loses the E/M value. Preventive and problem-oriented work must be clearly separated.
Frequently asked questions
The standard monthly premium is $202.90 in 2026, up from $185.00 in 2025, and the annual deductible is $283. Higher earners pay an income-related monthly adjustment amount (IRMAA) on top of the standard premium. After the deductible, Part B generally pays 80 percent of the Medicare-approved amount and the patient owes the remaining 20 percent.
Part B covers the professional and outpatient side: physician visits, outpatient surgery, lab tests, imaging, physical therapy, mental health services, most preventive screenings, and durable medical equipment. Part A covers inpatient facility care. A hospital stay usually produces both a Part A facility claim and Part B professional claims for the doctors involved.
Original Medicare Part B has no out-of-pocket maximum. After the annual deductible, the standard split is 80/20: Medicare pays 80 percent of the fee-schedule allowed amount and the beneficiary owes 20 percent coinsurance. That balance is billed to the patient, to a Medigap supplement, or to Medicaid if the patient is dual-eligible.
Sources & further reading
Reviewed by the ImmediCare Solutions RCM team
Certified billers and coders handling claims across 50+ specialties nationwide. This entry is reviewed against current payer policy and CMS rules. Last review: Jul 5, 2026.
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