What is Part B Medicare for?

Medicare Part B, or Medical Insurance, covers medically necessary outpatient services, doctors' visits, preventive care (like flu shots, cancer screenings), durable medical equipment (walkers, hospital beds), mental health services, ambulance rides, and some outpatient prescription drugs, complementing Part A (Hospital Insurance) by handling most non-hospital medical needs, with enrollees typically paying a monthly premium and a share of costs.

What is the purpose of Medicare Part B?

Medicare Part B (Medical Insurance) covers essential outpatient medical services, doctor visits, preventive care, and durable medical equipment not covered by Part A (hospital insurance). It helps pay for things like doctor's appointments, lab tests, ambulance services, mental health care, and screenings, acting as your day-to-day medical coverage to keep you healthy outside of inpatient hospital stays. 

What is the main difference between Medicare Part A and B?

Medicare Part A (Hospital Insurance) covers inpatient care like hospital stays, skilled nursing, hospice, and some home health, while Part B (Medical Insurance) covers outpatient services, doctor visits, preventive care, durable medical equipment, and lab tests, with Part A often premium-free for most, but Part B requiring a monthly premium and deductible for everyone. They work together as "Original Medicare," offering inpatient and outpatient coverage, with Part A focusing on facility costs and Part B on provider services. 

Does everyone on Medicare pay part B?

No, not everyone pays the same, but most people enrolled in Medicare Part B pay a monthly premium, with the amount depending on income, though some low-income individuals can get help or be exempt; Part B is optional but comes with a penalty if you delay enrollment without other creditable coverage. Higher earners pay more, while some individuals with Medicare and Medicaid have their premiums paid by the state. 

Do you 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 does Medicare Part B Cover?

What happens if I don't take Medicare Part B?

If you don't want Medicare Part B, you can decline it by following instructions in your Medicare welcome packet or by submitting Form CMS-1763 to Social Security, but you should only do so if you have other "creditable" coverage like a large employer plan (20+ employees) to avoid penalties later; otherwise, declining Part B means no coverage for doctor visits, outpatient care, and medical supplies, potentially costing more than premiums. 

Why would someone opt out of Medicare Part B?

A: There are several reasons why someone might not have Medicare Part B, including being covered by a group health plan based on current employment, being covered by a group health plan based on a spouse's current employment, or having coverage through Indian Health Services.

How do I avoid paying 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 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 monthly cost of Medicare Part B?

For 2026, the standard Medicare Part B monthly premium is $202.90, but it can be higher if your income is above a certain threshold or if you have a late enrollment penalty. Most people pay the standard amount, deducted from Social Security, with a $283 annual deductible before coverage starts. 

Why do seniors pay for Medicare Part B?

You must have Part B and keep paying your Part B premium to keep your Medigap policy. Medigap usually helps pay your portion of the costs (like deductibles and coinsurance) for services that Part A and Part B cover in Original Medicare.

What are the four things Medicare doesn't cover?

Some of the items and services Medicare doesn't cover include:

• A heart valve repair or replacement.
• An organ transplant.
• Cancer-related treatments.
• Dialysis services for the treatment of End-Stage Renal Disease (ESRD)

Is it better to have straight Medicare or a Medicare Advantage plan?

Neither Original Medicare nor Medicare Advantage (MA) is inherently "better"; the best choice depends on your health, budget, and lifestyle, with Original Medicare offering provider freedom and MA providing bundled benefits (dental/vision) and cost predictability via an out-of-pocket maximum, but often with network restrictions. Choose Original Medicare + Medigap for nationwide access and no networks, ideal for travelers or those wanting maximum choice, while Medicare Advantage suits those wanting all-in-one coverage (including drugs/extras like dental/vision) with lower upfront costs and a cap on yearly spending, provided they stay in-network. 

Do I need part B if I have other insurance?

You may not need Medicare Part B immediately if you have other insurance, especially from a large employer (20+ employees) where your job-based plan pays first; but you do need Part B if your other coverage is COBRA, retiree, VA, or from a small employer (under 20 employees), as Medicare becomes primary and your group plan secondary, requiring enrollment to avoid penalties and get full benefits. 

Does Medicare Part B cover 100%?

With Medicare Part B, you pay 20 percent of the cost for the services you use. So if your doctor charges $100 for a visit, then you are responsible for paying $20 and Part B pays $80. There is no limit on Part B coinsurance costs, which could add up if you have a lot of doctor visits or need other services.

Is Medicare Part B free at age 65?

No, Medicare Part B (Medical Insurance) is generally not free at age 65; most people pay a monthly premium, which can be higher for those with greater income, although Medicare Part A (Hospital Insurance) is often premium-free if you've paid Social Security taxes for about 10 years. While Part A is free for many, Part B covers doctor visits and outpatient care and requires a standard monthly payment, with the 2026 standard premium set at $202.90, plus potential penalties for late enrollment. 

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. 

Why are doctors dropping Medicare patients?

Physician Medicare reimbursement dropped 33% since 2000, when adjusted for inflation, according to the AMA. As a result, Ferguson said, many practices—particularly small, independent ones—can no longer afford to absorb the losses. "It's gotten to a point where you can't absorb it.

Does everyone have to pay $170 a month for Medicare?

If you don't get premium-free Part A, you pay up to $565 each month. If you don't buy Part A when you're first eligible for Medicare (usually when you turn 65), you might pay a penalty. Most people pay the standard Part B monthly premium amount ($202.90 in 2026).

Why would someone not want Medicare Part B?

While Part A is generally premium-free for most individuals, Part B does come with a monthly premium. If your existing coverage is sufficient and you have no immediate need for the services covered under Part B, you may decide to delay enrollment to avoid paying unnecessary premiums.

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.

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 will the monthly Medicare premiums be in 2026?

For 2026, the standard Medicare Part B premium is $202.90 monthly, an increase from 2025, with higher income earners paying more (Income-Related Monthly Adjustment Amount - IRMAA) and most people paying the standard rate unless they qualify for Extra Help. Part A premiums remain $0 for most, but higher for those with fewer work credits, while Part D costs vary by plan, but the national base beneficiary premium for penalty calculations rises to $38.99.
 

Do I 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.