Medicare Part B is the component of Original Medicare that covers doctors, outpatient services, lab tests, preventive care, and durable medical equipment. In 2026, the standard monthly premium is $185.00 — but beneficiaries with higher incomes pay Income-Related Monthly Adjustment Amount (IRMAA) surcharges that can push the total to $628.90 per month. Understanding when to enroll, how premiums are determined, and how to appeal IRMAA is essential for retirement healthcare planning.
Quick answer: Standard Medicare Part B premium is $185.00/month in 2026. The annual deductible is $257. Part B covers 80% of approved costs. High earners pay IRMAA surcharges based on income 2 years prior (2024 tax return). Enroll on time — missing the window creates a permanent 10% penalty per missed year.
Medicare Part B Premiums 2026
| 2024 Individual Income (MAGI) | 2024 Joint Income (MAGI) | 2026 Monthly Premium |
|---|---|---|
| ≤ $106,000 | ≤ $212,000 | $185.00 (standard) |
| $106,001–$133,000 | $212,001–$266,000 | $259.00 |
| $133,001–$167,000 | $266,001–$334,000 | $370.00 |
| $167,001–$200,000 | $334,001–$400,000 | $480.90 |
| $200,001–$500,000 | $400,001–$750,000 | $591.90 |
| > $500,000 | > $750,000 | $628.90 |
IRMAA is determined by your Modified Adjusted Gross Income (MAGI) from your 2024 federal income tax return — filed with the IRS in 2025. Social Security uses IRS data to determine your premium tier.
Annual deductible: $257 in 2026 (you pay this once per year before Medicare Part B benefits begin).
After the deductible: Medicare Part B covers 80% of the Medicare-approved amount. You pay 20% coinsurance with no out-of-pocket maximum (unless you have a Medigap plan).
What Medicare Part B Covers
Medically Necessary Services (80% after deductible)
- Primary care and specialist doctor visits
- Outpatient hospital procedures and surgeries
- Emergency department visits (outpatient)
- Ambulance services
- Mental health services (individual and group therapy)
- Substance use disorder services
- Lab tests and X-rays
- Physical, occupational, and speech therapy (outpatient)
- Durable medical equipment (wheelchairs, walkers, CPAP machines, oxygen)
- Home health services (after a qualifying hospital stay)
- Dialysis
Preventive Services (No cost-sharing)
- Annual wellness visit
- Flu, pneumococcal, hepatitis B vaccines
- Mammograms, colonoscopies, and other cancer screenings
- Cardiovascular disease and diabetes screenings
- Depression screening
- HIV screening
What Part B does NOT cover: Prescription drugs (covered by Part D), long-term care/custodial care, dental, vision, hearing aids, cosmetic surgery, or routine foot care.
Medicare Part B Enrollment: When to Sign Up
Initial Enrollment Period (IEP)
Your first opportunity to enroll in Part B is a 7-month window:
- 3 months before your 65th birthday month
- Your birthday month
- 3 months after your birthday month
Example: Birthday on September 15. IEP runs June 1 – December 31. If you enroll before September, Part B starts September 1. If you enroll in October, Part B starts December 1.
Special Enrollment Period (SEP) — Still Working
If you are covered by employer group health insurance from your or your spouse’s active employment at age 65, you can delay Part B enrollment without penalty. You get an 8-month Special Enrollment Period that starts when:
- Your employment ends, OR
- The employer health coverage ends
Whichever comes first. Important: COBRA and retiree health coverage do NOT qualify for the SEP — they do not count as active employer coverage for this purpose.
General Enrollment Period (GEP)
If you miss your IEP and do not qualify for a SEP, you can enroll during the General Enrollment Period: January 1 – March 31 each year. Coverage begins July 1 of that year. You also pay the late enrollment penalty.
Late Enrollment Penalty
If you do not enroll in Part B when first eligible (and do not have qualifying employer coverage), you pay a 10% penalty on the standard premium for each full 12-month period you were eligible but not enrolled.
This penalty is permanent — it applies for as long as you have Part B, for the rest of your life.
Example: You are eligible for Part B at 65 but wait until 68 to enroll (3 years late = 3 full 12-month periods).
- Standard premium 2026: $185.00
- Penalty: 3 × 10% = 30% surcharge
- Additional cost: $185.00 × 30% = $55.50/month
- Your premium: $240.50/month — permanently
Over 20 years of retirement, a 3-year delay penalty costs approximately $13,320 extra (at 2026 rates, before future premium increases).
How Part B Premiums Are Deducted
For most beneficiaries, Part B premiums are automatically deducted from your Social Security benefit each month. If you are not yet receiving Social Security, you receive a quarterly bill from Medicare and pay by check, online, or automatic bank withdrawal.
Are Medicare Part B Premiums Tax Deductible?
Self-employed individuals: 100% of Medicare Part B premiums (and other Medicare premiums) are deductible as the Self-Employed Health Insurance Deduction — taken above the line (no itemizing needed).
Retired/employed individuals: Part B premiums count as medical expenses. Medical expenses are deductible only if you itemize, and only the portion exceeding 7.5% of your Adjusted Gross Income (AGI) is deductible. At a $185/month premium ($2,220/year), this deduction is only accessible if you have significant other medical costs.
HSA funds: You cannot use HSA funds to pay for Medicare premiums once you are enrolled in Medicare — doing so disqualifies the HSA distribution tax exemption. Exception: Medicare premiums can be paid from an HSA if you are age 65 or older.
Appealing Your IRMAA Surcharge
IRMAA is based on 2024 tax return income. If your income has dropped significantly since then (retirement, job loss, divorce, death of spouse), you can file an appeal using Form SSA-44.
Qualifying life-changing events for IRMAA appeal:
- Marriage, divorce, or legal separation
- Death of a spouse
- Reduction in work hours or stopping work
- Loss of income-producing property (natural disaster, fraud)
- Employer settlement payments that artificially inflated prior income
- Loss of pension income (pension plan terminated)
You can request IRMAA be based on your most recent tax year instead of the two-year-prior default. Submit Form SSA-44 to your local Social Security Administration office.
Related Medicare and Healthcare Cost Resources
- Medicare IRMAA 2026 — full IRMAA brackets and how to manage surcharges
- Medicare Part D Guide 2026 — prescription drug coverage costs and enrollment
- Health FSA Guide 2026 — flexible spending accounts for medical costs
- HSA Contribution Limits 2026 — health savings account strategy
- Retirement Hub — complete 2026 retirement planning guide
Planning for Medicare Part B costs should begin years before retirement. If your income in your final working years will trigger IRMAA surcharges, strategies like Roth conversions, capital gain harvesting, and retirement account sequencing can help manage your 2-years-prior income level — keeping your Part B premium at the standard rate.
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