What does Part B cover?
Part B covers two kinds of services: medically necessary services to diagnose or treat a condition, and preventive services to catch problems early.
- Doctors and other clinicians: office visits, specialists, surgeons, and doctors' services during a hospital stay.
- Outpatient care: emergency room visits, outpatient surgery, observation stays, lab tests, X-rays and imaging.
- Preventive services: the Welcome to Medicare visit, yearly wellness visits, many cancer screenings, flu, COVID-19, pneumonia and hepatitis B shots, and more. Many cost you nothing if your provider accepts assignment.
- Durable medical equipment: walkers, wheelchairs, hospital beds, oxygen and diabetes testing supplies.
- Ambulance rides when other transportation could endanger your health.
- Outpatient mental health care, including some telehealth visits.
- Physical, occupational and speech therapy.
- Some drugs given in a doctor's office or clinic, such as many injections and infusions, and insulin used with a pump, which costs no more than $35 for a month's supply.
Part B doesn't cover routine dental care, hearing aids, routine eye exams for glasses, or most prescription drugs you fill at a pharmacy; those go to Part D. See Medicare basics.
What does Part B cost in 2026?
| Cost | 2026 amount |
|---|---|
| Standard monthly premium | $202.90 |
| Yearly deductible | $283 |
| Coinsurance after the deductible | Usually 20% of the Medicare-approved amount |
| Premium with income above $109,000 (single) or $218,000 (joint) | From $284.10 a month (IRMAA) |
Original Medicare has no yearly limit on the 20% you pay. That's why many people add a Medigap policy or choose a Medicare Advantage plan, which has a yearly out-of-pocket limit. IRMAA uses your modified adjusted gross income from 2 years earlier (your 2024 tax return for 2026) and can be appealed after a life-changing event such as retirement; try the IRMAA calculator. CMS publishes 2027 Part B amounts in the fall; see Medicare costs in 2027.
What does "accepts assignment" mean?
A provider who accepts assignment agrees to take the Medicare-approved amount as full payment. You pay only your deductible and 20% coinsurance. Providers who participate in Medicare but don't accept assignment on a claim can charge up to 15% more (the limiting charge). Ask before your visit. You can look up Ohio doctors on Medicare's Care Compare.
When should I sign up for Part B?
Most people sign up during their 7-month Initial Enrollment Period around 65. If you already get Social Security, you're enrolled automatically and can decline Part B by following the card's instructions. If you or your spouse are still working with job-based coverage at an employer with 20 or more employees, you can usually delay Part B and sign up later in a special enrollment period with forms CMS-40B and CMS-L564. See working past 65.
Late penalty: if you go without Part B when you could have had it and you didn't have job-based coverage from current work, your premium goes up 10% for each full 12-month period you waited, usually for as long as you have Part B. If you miss your window, the General Enrollment Period runs January 1 to March 31, and coverage starts the month after you sign up. Estimate it with the late enrollment penalty calculator.
COBRA, retiree coverage and VA health care don't count as coverage from current work, so they don't let you delay Part B without a penalty.
How do I pay the Part B premium?
If you get Social Security or Railroad Retirement benefits, the premium comes out of your monthly payment. If you don't, Medicare bills you every month (or every 3 months). Many Ohio public retirees fall in this group because their teaching or public-service pension replaced Social Security. You can pay online through your Medicare account, set up Medicare Easy Pay to have it deducted from your bank account, use your bank's online bill pay, or mail a check. Pay on time: unpaid premiums can end your Part B coverage.
Ohio retirement systems and Part B
- STRS Ohio requires every medical plan enrollee to enroll in Part B when first eligible; declining Part B (or premium-free Part A) ends STRS Ohio medical coverage (OAC 3307:1-11-03).
- SERS says everyone enrolling in its Medicare coverage must enroll in Part B, and SERS coverage starts the month after SERS receives proof of your Part B.
- OPERS requires Medicare-eligible benefit recipients to enroll in Parts A and B and to choose a plan through the OPERS Medicare Connector to receive its monthly HRA deposits. You pay your own Part B premium.
- OP&F and HPRS also tie retiree health care to Medicare. See OP&F and Medicare and HPRS and Medicare.
Rules and amounts change; check your system's current guide. See Ohio public retirement systems and Medicare and OPERS vs. STRS vs. SERS retiree coverage.
Help paying Part B in Ohio
Ohio calls its Medicare Savings Programs "Medicare Premium Assistance Programs." In 2026 they help people with monthly income up to about $1,816 (single) or $2,455 (couple) and resources up to $9,950 (single) or $14,910 (couple):
- QMB (income up to $1,350 single): pays Part A and Part B premiums, deductibles and coinsurance.
- SLMB (up to $1,616 single) and QI-1 (up to $1,816 single): pay the Part B premium.
Anyone approved also gets Extra Help with Part D automatically. Apply at benefits.ohio.gov or your county Job and Family Services office, or call the Ohio Medicaid Consumer Hotline at 1-800-324-8680. See Medicare Savings Programs in Ohio and the savings programs calculator.
Next steps
Sign up for Part B through Social Security at ssa.gov or 1-800-772-1213 (TTY 1-800-325-0778). To review how Medigap or Medicare Advantage would work alongside Part B with plans from the companies they work with, you can request a call from a licensed insurance agent. For other questions, call 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048).
Sources
- Medicare.gov — What Part B covers
- Medicare.gov — Preventive and screening services
- Medicare.gov — Does your provider accept Medicare as full payment?
- CMS — 2026 Medicare Parts A and B premiums and deductibles
- Medicare.gov — Avoid late enrollment penalties
- Medicare.gov — Pay your premiums
- Social Security — Premiums: rules for higher-income beneficiaries (IRMAA)
- Ohio Administrative Code 3307:1-11-03 — STRS Ohio medical plan
- SERS — 2027 Member Healthcare Guide
- OPERS — 2026 Health Care Program Guide
- Ohio Administrative Code 5160:1-3-02.1 — Medicare premium assistance programs
- Medicare.gov — Medicare Savings Programs (2026 limits)
Frequently asked questions
How much is Medicare Part B in 2026?
The standard Part B premium is $202.90 a month and the deductible is $283 for the year. People with higher incomes pay more through IRMAA, starting above $109,000 of income for a single filer or $218,000 for a joint return, based on the tax return from 2 years earlier.
Do I have to take Part B?
Part B is voluntary, but if you don't sign up when you're first eligible and don't have job-based coverage from your or your spouse's current work, you'll likely owe a late penalty for as long as you have Part B. Many Ohio retiree plans, TRICARE For Life and Medigap also expect you to have Part B.
How do I pay Part B if I don't get Social Security?
If you don't get Social Security, Railroad Retirement or federal retirement benefits, Medicare sends you a bill. You can pay online through your Medicare account, sign up for Medicare Easy Pay automatic deductions, or pay through your bank's bill-pay service. This is common for Ohio public retirees who never paid into Social Security.
What is the Part B late enrollment penalty?
Your monthly premium goes up 10% for each full 12-month period you could have had Part B but didn't, and you usually pay it as long as you have Part B. If you qualified for a special enrollment period because of job-based coverage from current work, there's no penalty.
Can Ohio help pay my Part B premium?
Yes, if your income and resources are limited. Ohio's Medicare Premium Assistance Programs (QMB, SLMB and QI-1) pay the Part B premium, and QMB also pays Medicare deductibles and coinsurance. Apply at benefits.ohio.gov or your county Job and Family Services office.
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