What are the rules for Medicare Part B?

Medicare Part B rules cover eligibility (usually 65+, citizen/resident, worked 10 yrs), enrollment (around turning 65 or with disability), costs (premium, deductible, 20% coinsurance), and what's covered (doctors, outpatient care, preventive services, DME), emphasizing signing up on time to avoid lifelong penalties, with higher incomes paying more (IRMAA).

What is the Medicare Part B rule?

Medicare Part B helps cover medical services like doctors' services, outpatient care, and other medical services that Part A doesn't cover. Part B is optional. Part B helps pay for covered medical services and items when they are medically necessary.

What are the biggest mistakes people make with Medicare?

The biggest Medicare mistakes involve missing enrollment deadlines, failing to review plans annually, underestimating total costs (premiums, deductibles, copays), not enrolling in a Part D drug plan with Original Medicare, and assuming one-size-fits-all coverage or that Medicare covers everything like long-term care. People often delay enrollment, get locked into old plans without checking for better options, or overlook financial assistance programs, leading to higher out-of-pocket expenses and penalties. 

What is the eligibility requirement for Medicare Part B?

To be eligible for Medicare Part B, you generally must be 65 or older, a U.S. citizen or permanent resident for at least 5 years, and either receiving Social Security benefits or qualify for premium-free Part A; if not, you can still enroll by paying a monthly premium, and individuals under 65 with certain disabilities (like SSDI for 24 months or ESRD/ALS) also qualify. 

Is there an income limit for Medicare Part B?

Medicare Part B has income limits, called IRMAA (Income-Related Monthly Adjustment Amount), where higher Modified Adjusted Gross Income (MAGI) leads to higher premiums, with 2026 brackets starting above $109,000 for individuals and $218,000 for couples, based on your 2024 tax return, with higher earnings pushing you into surcharges added to the standard $202.90 premium. For example, individuals earning over $109,000 (up to $137,000) pay the standard premium plus an $81.20 surcharge, while higher earners pay even more, with substantial jumps at higher income levels.
 

Medicare Part B 2026 Explained - What’s Changing and What It’ll Cost You

Can you make too much money for Medicare Part B?

You cannot make too much money to qualify for Medicare. Eligibility is based on age or disability status, not income. That said, higher earnings can trigger income-based surcharges on premiums, particularly for Part B and Part D coverage.

What are the income brackets for Medicare Part B premiums?

Medicare Part B premiums are based on your Modified Adjusted Gross Income (MAGI) from two years prior, with higher incomes paying more through an Income-Related Monthly Adjustment Amount (IRMAA), starting at $109,000 for individuals and $218,000 for joint filers in 2026, leading to tiers that go up to $689.90 monthly for the highest earners, while the standard premium for 2026 is $202.90.
 

How can I avoid paying for Medicare Part B?

You can avoid the Medicare Part B premium by delaying enrollment if you have creditable employer coverage (from a current job with 20+ employees) or by qualifying for a Medicare Savings Program (MSP) to have the state pay it, but generally, you must enroll during your Initial Enrollment Period (IEP) or face lifelong penalties if you don't have other qualifying coverage. If you have other creditable insurance, you can delay Part B and sign up later within 8 months of that coverage ending without penalty. 

What are the disadvantages of delaying Medicare Part B?

Part B late enrollment penalty

You'll pay an extra 10% for each year you could have signed up for Part B, but didn't. You may also pay a higher premium depending on your income.

What determines what you pay for Medicare Part B?

Medicare Part B premiums are calculated based on your Modified Adjusted Gross Income (MAGI) from your tax return filed two years prior, with higher incomes paying an Income-Related Monthly Adjustment Amount (IRMAA) on top of the standard premium, which is determined by a sliding scale set by the Social Security Administration and CMS each year. The Social Security Administration pulls your tax info from the IRS to figure this out, adding tax-exempt interest to your AGI to get MAGI, and if you're married filing jointly, they look at your combined income. 

Is it better to go on Medicare or stay on private insurance?

Neither Medicare nor private insurance is universally "better"; the best choice depends on individual needs, but Medicare often offers lower overall costs and simplicity for seniors, while private insurance excels in covering dependents and potentially offering more choice with networks/out-of-pocket caps, though at higher premiums. Medicare boasts lower admin costs and standardized coverage, but Original Medicare lacks an out-of-pocket maximum, a feature typically found in private plans and Medicare Advantage (Part C). 

What are the three words to remember for a Medicare wellness exam?

For a Medicare Wellness Exam's cognitive test, the three common words to remember are often "banana," "sunrise," and "chair," used in the Mini-Cog screening to check your memory and thinking skills; you say them immediately and then recall them after a few minutes. 

What is the 3 day rule for Medicare?

Medicare's "3-Day Rule" is a requirement for Skilled Nursing Facility (SNF) coverage: you must have a medically necessary 3-consecutive-day inpatient hospital stay (not counting discharge or observation time) before Medicare pays for SNF care, generally starting within 30 days of discharge. This rule ensures SNF stays are for recovery after significant hospital care, though Medicare Advantage plans or certain CMS initiatives (like ACOs/TEAM model) may offer waivers allowing direct SNF admission from home or shorter hospital stays.
 

Does a person really need Medicare Part B?

You need Medicare Part B if you're 65+ and don't have other creditable health coverage (like from a large employer or union), or if you have retiree coverage, Medicaid, or COBRA and want to avoid penalties, as Part B covers doctor visits, outpatient care, medical supplies, and preventive services, making it a crucial part of your health plan when it's primary. Delaying enrollment can lead to permanent late enrollment penalties unless you have qualifying coverage, so it's essential to enroll during your Initial Enrollment Period (IEP) or a Special Enrollment Period (SEP) if you're still working. 

What is the new Medicare rule for 2025 for seniors?

In 2025, the biggest Medicare changes for seniors focus on Prescription Drug coverage (Part D) with a new $2,000 annual out-of-pocket cap, eliminating the "donut hole," allowing monthly payments for drug costs, and introducing price negotiations, while Medicare Advantage plans face potential benefit adjustments, and Part B premiums and deductibles will increase. Expect some MA plans to reduce extra perks to offset new drug costs, plus updates to telehealth and integrated care options. 

Does everyone pay $170 for Medicare Part B?

Costs for Part B (Medical Insurance)

$185 each month ($202.90 in 2026) (or higher depending on your income). The amount can change each year. You'll pay the premium each month, even if you don't get any Part B-covered services.

What does Dave Ramsey say about Medicare?

Dave Ramsey's Medicare advice centers on planning ahead, understanding enrollment periods to avoid penalties, using Health Savings Accounts (HSAs) if possible, and supplementing Original Medicare with Medigap or Medicare Advantage (Part C) to cover gaps like dental, vision, and long-term care, stressing that mistakes can be costly and recommending expert advice for personalized choices. 

How can I lower my Medicare premiums?

To lower Medicare premiums, report income drops from life events like retirement (Form SSA-44), apply for low-income help like Extra Help or Medicaid, use HSA funds for premiums, deduct premiums from taxes, switch to a cheaper Medicare Advantage or Supplement plan, or check if you qualify for Medicare Savings Programs (MSPs) through your state. 

What happens if you can't afford Medicare Part B?

If you can't afford to pay your Medicare premiums and other medical costs, you may be able to get help from your state. States offer Medicare Savings Programs for people entitled to Medicare who have limited income. Some programs may pay for Medicare premiums and some pay Medicare deductibles and coinsurance.

Why do people opt out of Medicare Part B?

Income too high – Higher earners pay a higher standard Part B monthly premium amount due to Income Related Monthly Adjustment Amounts (IRMAA). Some opt out due to premium costs. Failure to pay premiums – Part B coverage can be terminated if premium payments are delinquent for 12 continuous months.

At what age do you stop paying Medicare premiums?

Your CalPERS health coverage will automatically be canceled the first day of the month after you turn 65. See Cancellation of CalPERS Health Coverage for information on reinstating your health coverage.

Can I deduct my Medicare Part B premiums on my taxes?

Yes, your monthly Medicare Part B premiums are tax-deductible. However, you can only benefit from the medical expense deduction by following specific rules. You'll need to file your taxes in a certain way, itemizing your deductions instead of choosing the standard deduction.

What factors affect my Part B premium?

If we determine you're a higher-income beneficiary, you'll pay a larger percentage of the total cost of Part B based on the income you normally report to the Internal Revenue Service (IRS). You'll pay monthly Part B premiums equal to 35%, 50%, 65%, 80%, or 85% of the total cost, depending on what you report to the IRS.

What is the average monthly cost for Medicare Part B?

For 2026, the standard Medicare Part B premium is $202.90 per month, an increase from the 2025 rate, though some people pay more (Income-Related Monthly Adjustment Amount, IRMAA) or less due to "hold harmless" rules. The exact amount depends on your income and when you enrolled, with higher earners paying significantly more and some beneficiaries shielded from large increases by Social Security cost-of-living adjustments.