What Medicare covers
What does Medicare Part B cover, and what is left for you?
Part B is the medical insurance half of Original Medicare: doctor visits, outpatient care, tests, preventive services and equipment. The estimator prices a Part B service with your area and coverage.
What this service costs you
You pay
$95
| Medicare-approved amount | $95 |
| Part B deductible used | $95 |
| Deductible left after this | $188 |
Part B: you pay the yearly deductible ($283 in 2026), then 20% of the approved amount.
How this is calculatedMedicare Part B is the medical insurance of Original Medicare and pays for two kinds of care: services that are medically necessary to diagnose or treat a condition, and preventive services that catch illness early. In practice that means doctor visits, outpatient surgery and hospital outpatient care, lab tests and imaging, ambulance rides, durable medical equipment such as a CPAP or a wheelchair, mental health care, outpatient therapy and a limited list of outpatient prescription drugs. In 2026 the standard premium is $202.90 a month and the deductible $283 a year; after that you pay 20% of the Medicare-approved amount, with no yearly ceiling. A follow-up office visit approved at $95 nationally leaves you $19; an emergency room visit for a moderately severe problem leaves you $109 with its hospital copayment; a screening mammogram costs you $0 when the provider accepts assignment. Hearing aids, routine dental care and eye exams for glasses sit outside Part B.
Your 20% of a Part B bill
You pay
$100
| Approved amount | $500 |
| Deductible | $0 |
| 20% coinsurance | $100 |
| Limiting charge above it | $0 |
Costs computed by Radif Partners · Editorial policy · How the costs are calculated
Two kinds of services
Medicare.gov sorts everything Part B pays for into two groups. Medically necessary services are the services and supplies that meet accepted standards of medical practice to diagnose or treat your condition: the visit when you are sick, the scan your doctor orders, the surgery done without an overnight admission, the walker you need after a fall. Preventive services are care meant to prevent illness or find it at an early stage, such as the yearly wellness visit, screening mammograms and screening colonoscopies. Most preventive services cost you nothing when the provider accepts assignment; medically necessary services follow the deductible and the 20%.
The Part B coverage page lists, among others, ambulance services, clinical research, durable medical equipment, limited outpatient prescription drugs, mental health and substance use disorder care, and oxygen equipment. Each service on this site has its own page with its own rules: how often it is covered, who qualifies and where it can be done.
The 2026 figures that drive every Part B bill
| Item | 2026 amount | How it works |
|---|---|---|
| Standard monthly premium | $202.90 | Paid every month, whatever care you use |
| Yearly deductible | $283 | You pay approved amounts until it is reached; resets each January |
| Coinsurance | 20% | Of the approved amount, after the deductible, with no yearly cap |
| Cap on one hospital outpatient copayment | $1,736 | Equal to the Part A deductible |
| Insulin used in a pump | $35 a month at most | No deductible |
The 2027 premium and deductible are not published yet. CMS releases them in its yearly fact sheet, expected in mid-November 2026; until then every amount on this site is the 2026 one.
What common Part B services cost you
| Service | Where | Approved | You pay |
|---|---|---|---|
| Doctor office visit, established patient (typical 20-30 minutes) | Office | $95 | $19 |
| Yearly wellness visit | Office | $138 | $0 |
| Screening mammogram (yearly) | Office | $126 | $0 |
| Diagnostic mammogram, both breasts | Imaging center | $157 | $31 |
| MRI of the brain without contrast | Imaging center | $195 | $39 |
| MRI of the brain without contrast | Hospital outpatient | $312 | $62 |
| Emergency room visit, moderately severe problem | Hospital | $545 | $109 |
| Physical therapy session (three 15-minute units of exercise) | Office | $87 | $17 |
| CPAP machine for sleep apnea (13-month rental) | Supplier, 13 months, Florida | $545 | $109 |
The same scan costs more in a hospital outpatient department than at an imaging center, because the hospital adds its own copayment to the radiologist's 20%. When you have a choice of place, ask before booking.
The deductible comes first
In January your first bills go to the deductible. A follow-up visit that leaves you $19 in June costs you $95 when it is the first Part B bill of the year, because the whole approved amount counts toward the $283. The deductible page follows a year of bills step by step.
Your 20% of a Part B bill
You pay
$100
| Approved amount | $500 |
| Deductible | $0 |
| 20% coinsurance | $100 |
| Limiting charge above it | $0 |
Assignment, non-participating doctors and opt-outs
Most doctors accept assignment: they take the approved amount as full payment, bill Medicare themselves and ask you only for the deductible and coinsurance. A non-participating doctor may accept assignment case by case or bill you up to the limiting charge: on our sample visit the approved amount drops to $90 and the bill can rise by $14. A provider who has opted out of Medicare signs a private contract with you, and Medicare pays nothing for that care, except in an emergency or urgent need. The medicare.gov assignment page gives these rules.
Outside Part B
Part B leaves out hearing aids and the exams to fit them, most dental care, eye exams for glasses, long-term care that is not medical, cosmetic surgery, routine physical exams and concierge care. Those costs are yours unless other coverage pays them; the list of what Medicare does not cover prices them. A Medicare Advantage plan must cover at least what Part B covers, often with its own copays and extra benefits.