Medicare Part B Coverage

Most people become eligible for Medicare three months before they turn 65. This begins what is known as the Initial Enrollment Period. The Initial Enrollment Period is the 7-month window that starts three months before your 65th birthday, the month you turn 65, and three months after your 65th birthday.

During this period, you can manually enroll in both Part A and B if you're not automatically enrolled.

There are out-of-pocket costs you should be mindful of when it comes to Medicare Part B. The standard monthly premium for Part B in 2026 is $202.90, while the deductible is $283. Keep in mind that the Part B premium varies among individuals and is dependent on income. If you make an income that's in a higher bracket, you'll likely pay more as a premium.

An outpatient coverage review looks at how Part B is working for the care you actually use: doctor visits, lab work, outpatient physical, occupational, and speech therapy, and durable medical equipment such as walkers, wheelchairs, and oxygen supplies. We walk through the services you rely on and flag anywhere the coverage rules or your costs have changed.

Reviews matter more than they used to. Medicare Advantage plans routinely require prior authorization before approving outpatient services, and beginning in 2026 the WISeR model adds a similar pre-service review to a short list of Part B services under Original Medicare in select states. Knowing which of your services fall under these reviews helps you avoid surprise denials.

Even when a service is covered, costs can still show up. After the annual deductible, Part B generally pays 80 percent of the approved amount, leaving you the remaining 20 percent with no yearly cap unless you carry supplemental coverage. A review is the simplest way to see where that 20 percent is landing.

Part B includes a long list of preventative services: the yearly wellness visit, screenings for cancer, diabetes, and heart disease, and vaccines such as flu, COVID-19, and pneumonia, with the shingles vaccine covered at no cost through Part D. Most preventative services cost you nothing when your provider accepts Medicare assignment.

The catch is that a no-cost screening can turn into a billed service. If your doctor finds and removes a polyp during a screening colonoscopy, or orders follow-up tests after a wellness visit, that additional care is billed as diagnostic, and the deductible or coinsurance can apply.

Before scheduling care, ask whether the visit is coded as preventative or diagnostic, whether the provider accepts assignment, and how often Medicare covers that particular screening. We review your preventative benefits with you so you know what to expect before the appointment.