Care About Mom

If you’ve ever tried to read a Medicare explanation of benefits, you already know that Medicare’s coverage rules weren’t written for regular people. Medicare Part B, in particular, confuses many families — it covers some things, doesn’t cover others, and has a cost-sharing structure that isn’t always obvious.

This guide explains Medicare Part B in plain English: what it covers, what it costs, what it doesn’t include, and how to use it effectively for an aging parent.

What Is Medicare Part B?

Medicare has several parts, and each covers different services:

• Part A covers hospital stays, skilled nursing facility care, some home health care, and hospice
• Part B covers outpatient medical services, preventive care, and medically necessary services
• Part C (Medicare Advantage) is an alternative to original Medicare offered by private insurers
• Part D covers prescription drugs

Most people think of Part B as covering “doctor visits” — and that’s a good start, but it’s much broader than that.

What Does Medicare Part B Cover?

Medically Necessary Services

Part B covers services that are “medically necessary” — meaning your parent’s doctor determines they’re needed to diagnose or treat a medical condition. This includes:

• Doctor visits (primary care and specialists)
• Outpatient surgery and procedures
• Emergency room visits (though Part A may apply if admitted)
• Ambulance services
• Mental health services (therapy, psychiatric evaluations)
• Physical therapy, occupational therapy, speech therapy
• Durable Medical Equipment (DME) — wheelchairs, walkers, hospital beds, oxygen equipment
• Lab tests and X-rays
• Outpatient kidney dialysis
• Some home health care (when following a hospital or skilled nursing facility stay, or when ordered by a doctor)
• Chemotherapy and radiation treatment (outpatient)
• Cardiac and pulmonary rehabilitation

Preventive Services

This is one of the most underused benefits in Medicare. Part B covers many preventive services at no cost — meaning no copay or coinsurance — when provided by a participating provider. These include:

• Annual Wellness Visit — not a physical exam, but a personalized prevention plan. Different from a regular visit and free once per year.
• Flu shots, pneumonia vaccines, COVID-19 vaccines, hepatitis B vaccines
• Mammograms (annually for women over 40)
• Colonoscopy (every 10 years for average risk; more frequently if higher risk)
• Cardiovascular disease screenings
• Diabetes screening and diabetes self-management training
• Bone density tests
• Depression screening
• Glaucoma testing (annually for high-risk individuals)

What Does Medicare Part B NOT Cover?

This is equally important to understand, because families are often blindsided by gaps in coverage:

• Prescription drugs (covered by Part D or Medicare Advantage)
• Routine dental care — cleanings, fillings, dentures (major gap in Medicare coverage)
• Routine vision care — eye exams for glasses, eyeglasses themselves
• Routine hearing exams and hearing aids (another major gap)
• Custodial care / long-term care — help with daily activities like bathing, dressing, and eating, when that’s the only care needed. This is a critical distinction many families miss.
• Most care outside the U.S.
• Cosmetic surgery
• Acupuncture (with some exceptions)

The lack of dental, vision, and hearing coverage is one of the biggest gaps in original Medicare. Some Medicare Advantage plans do offer these benefits, which is one reason those plans have grown in popularity.

How Much Does Medicare Part B Cost?

Monthly Premium

Most Medicare beneficiaries pay a standard monthly premium for Part B. In 2026, the standard premium is $185.00 per month. However, higher-income beneficiaries pay more through a surcharge called IRMAA (Income-Related Monthly Adjustment Amount). If your parent’s income was above $106,000 (individual) or $212,000 (married filing jointly) two years ago, they may pay a higher premium.

Annual Deductible

Part B has an annual deductible ($257 in 2026). Once that’s met, Medicare typically pays 80% of approved costs and your parent pays the remaining 20% — with no cap on out-of-pocket costs for that 20%. This is why Medigap (supplemental insurance) is so valuable for those on original Medicare.

The 20% Coinsurance: A Real Risk

That 20% coinsurance sounds manageable until you do the math on a major medical event. If your parent has a $100,000 cancer treatment course, they’d owe $20,000. There is no cap. This is why most people on original Medicare also carry either a Medigap policy (which covers most or all of the 20%) or are in a Medicare Advantage plan (which has different cost-sharing structures).

How to Enroll in Medicare Part B

Enrollment in Part B is time-sensitive — and missing the window can result in permanent premium penalties.

• Initial Enrollment Period: 7-month window starting 3 months before the month of turning 65
• Special Enrollment Period: Available for those covered by employer insurance through an active job — they can delay Part B without penalty and enroll later
• General Enrollment Period: January 1 – March 31 each year, for those who missed their initial window — but with a 10% permanent premium penalty for each 12-month period of delay

Many people delay Part B if they’re still working and covered by employer insurance — that’s typically fine. But COBRA and retiree coverage do NOT count as the kind of coverage that allows penalty-free delay.

Tips for Using Part B Effectively

• Schedule the Annual Wellness Visit every year. It’s free, and it establishes a health baseline and care plan. Many families don’t know this is different from a regular physical.
• Always confirm a provider accepts Medicare before appointments. Providers can “opt out” of Medicare entirely, meaning Medicare won’t pay at all.
• Understand “assignment.” Providers who accept “assignment” agree to Medicare’s approved rate. Those who don’t can charge up to 15% more.
• Know what “medically necessary” means. If Medicare denies a claim, you can appeal — and appeals are often successful, especially with a doctor’s supporting documentation.
• Keep an Explanation of Benefits (EOB) for every claim and review them for errors or billing discrepancies.

Frequently Asked Questions

Does Medicare Part B cover physical therapy?

Yes. Part B covers outpatient physical therapy, occupational therapy, and speech-language pathology when medically necessary and ordered by a physician. There used to be a cap on therapy services, but that cap was eliminated. Coverage continues as long as the therapy is medically necessary.

Does Part B cover a walker or wheelchair?

Yes — this falls under Durable Medical Equipment (DME). Part B covers 80% of the approved cost after the deductible, for equipment deemed medically necessary by a doctor. The equipment must be ordered by a Medicare-enrolled physician from a Medicare-enrolled supplier.

Does Medicare Part B cover mental health services?

Yes. Part B covers outpatient mental health services including visits with psychiatrists, psychologists, clinical social workers, and other qualified providers. Medicare pays 80% after the deductible for most mental health services — the same cost-sharing as other Part B services.

What’s the difference between a “Welcome to Medicare” visit and an Annual Wellness Visit?

The “Welcome to Medicare” preventive visit is a one-time visit available in the first 12 months of Part B enrollment. It includes a review of medical history, a health risk assessment, and referrals for screenings. The Annual Wellness Visit is available every year after that and creates or updates a personalized prevention plan. Both are free (no cost-sharing).

Final Thoughts

Medicare Part B is a significant benefit that most seniors rely on for the majority of their medical care — but it has real gaps and cost-sharing responsibilities that families need to understand. Knowing what’s covered (and what’s not) helps you plan, avoid surprise bills, and make sure your parent is getting every benefit they’re entitled to.

If you have questions about specific coverage situations, Medicare.gov has a coverage search tool, and your State Health Insurance Assistance Program (SHIP) offers free one-on-one counseling — searchable at shiphelp.org.