Educational content only. Not Medicare, insurance, or financial advice. Not affiliated with CMS, Medicare.gov, or SSA.
By Keith Guirao, founder and editor of Savvy Senior Central (Maven Media).
Part B is Medical Insurance, doctors, outpatient care, home health, durable medical equipment, and many preventive services. It is not Hospital Insurance. It is not a private plan premium you can “$0 away.” You pay for Part B every month even if you get no Part B services that month.
Official 2026 amounts, published by CMS on November 14, 2025, and restated on Medicare.gov and in *Medicare & You 2026*:
- Standard monthly premium: $202.90. Most people pay this. Social Security tells you the exact amount on your notice.
- Annual deductible: $283, once each year, before Original Medicare starts to pay its share of Part B services.
- Coinsurance: usually 20% of the Medicare-approved amount after the deductible, if the provider accepts assignment.
There is no yearly limit on what you pay out of pocket on Original Medicare alone. The usual 20% has no published ceiling unless you add other coverage (Medigap, Medicaid, employer, retiree, or union) or you join a Medicare Advantage Plan.
Higher-income people pay more through IRMAA. the income-related monthly adjustment amount. CMS says IRMAA affects roughly 8% of people with Part B. Exact brackets change; prefer the live SSA IRMAA tables and the CMS fact sheet over any broker chart that will go stale.
I have spent 18 years inside consumer marketing and lead generation in insurance and health. That is operator experience, not a counseling credential. The enrollment form is built to treat Part B as background noise. The monthly bill is not noise.
What Part B is and what it is not
Original Medicare is Part A (Hospital Insurance) plus Part B (Medical Insurance). You have Original Medicare unless you join a Medicare Advantage Plan. That is the CMS default, not a sales pitch.
Part A helps cover inpatient hospital care, skilled nursing facility care, hospice, and some home health. Part B is the outpatient half: physicians’ services, outpatient hospital services, certain home health, durable medical equipment (wheelchairs, walkers, hospital beds), and many preventive services (screenings, shots or vaccines, yearly “Wellness” visits). Medicare.gov: you pay $0 for most preventive services if your provider accepts the Medicare-approved amount as full payment. That is an assignment rule, not a free-physical rule. Original Medicare still does not cover routine physical exams, eye exams for glasses, most dental care, hearing aids, or fitting exams.
Part B is also not a drug plan. Outpatient drugs you typically give yourself sit in Part D (or other drug coverage). Part B covers a limited set of drugs under specific conditions, often drugs you would not give yourself, such as those given in a doctor’s office or hospital outpatient setting.
You still pay Part B in Medicare Advantage
To join Advantage you need Part A and Part B. You still have Medicare. You get most A and B coverage from the plan and use the plan card. You still pay the Part B premium.
Medicare.gov’s compare page: you pay the monthly Part B premium and may also have to pay the plan’s premium. Some plans may have a $0 plan premium and may help pay all or part of your Part B premium. CMS’s Understanding Medicare Advantage Plans booklet is blunt: you still have to pay the Part B premium. Most people pay the standard amount every month.
In 2026 that standard is $202.90. IRMAA, if it applies, still applies in Advantage. A late-enrollment penalty, if it applies, still applies. The plan does not erase either one. A $0 *plan* premium is a plan rule that can change each year, not a cancellation of the federal Part B bill.
IRMAA: the two-year lookback surcharge
IRMAA is not a plan surcharge and not a late fee. Social Security adds it to the Part B premium (and, separately, to Part D if you have drug coverage) when modified adjusted gross income (MAGI) is above a threshold. SSA defines MAGI as total adjusted gross income plus tax-exempt interest.
Thresholds that trigger higher premiums (2026🙂 if you file married filing jointly and MAGI is greater than $218,000, or you file using a different status and MAGI is greater than $109,000, you pay higher Part B and Part D premiums. Those are SSA’s published trigger lines. The full sliding-scale brackets and dollar add-ons live on SSA’s page and CMS’s November 14, 2025 fact sheet. Use those live tables rather than a marketplace screenshot.
SSA uses the most recent federal tax return the IRS provides. For 2026 amounts, that is generally a return filed in 2025 for tax year 2024 (a two-year lookback). *Medicare & You 2026* restates that Medicare uses MAGI from your IRS tax return from two years ago. If you must pay IRMAA, SSA sends a letter with the amounts and the reason.
Illustrative CMS anchors (full Part B coverage, 2026, not a substitute for the live table:)
- Standard (at or under the thresholds above): total Part B $202.90/month (IRMAA $0).
- Top CMS tier (individual MAGI ≥ $500,000, or joint ≥ $750,000): IRMAA $487.00; total monthly Part B $689.90.
Between those poles, CMS publishes intermediate IRMAA add-ons ($81.20, $202.90, $324.60, $446.30 on the individual/joint ladder). Married people who lived with a spouse during the year but file separately have a compressed CMS ladder. Read the current amounts on SSA) before you budget. Bracket edges matter: one dollar of MAGI can jump a whole tier.
Part D has its own IRMAA add-on on top of your plan premium (CMS also says roughly 8% of Part D enrollees pay it). SSA ties Part D IRMAA to the national base beneficiary premium logic, not your own plan’s sticker price. You pay Part D IRMAA even inside an Advantage plan that includes drugs. Live Part D IRMAA dollars are on the same SSA and CMS pages.
If income dropped because of a life-changing event SSA lists (marriage, divorce, death of a spouse, work stoppage or reduced hours, loss of income-producing property beyond your control, pension-plan cessation, or an employer settlement from closure, bankruptcy, or reorganization), SSA says you can request a new decision, including with Form SSA-44. If you disagree with the determination itself, SSA says you have the right to appeal (including online) or with Form SSA-561-U2. If the MAGI figure from IRS is wrong, SSA says to correct it with IRS. This page does not tell you to file either form, it points you to SSA’s process.
The late enrollment penalty is not a one-time fee
Medicare.gov: late enrollment penalties are added to the monthly premium, are not a one-time late fee, and are usually charged for as long as you have that coverage (for most people, a lifetime penalty for Part B). They go up the longer you wait.
For Part B you pay an extra 10% for each full 12-month period you could have signed up but did not. *Medicare & You 2026* restates that rule. Partial years do not count as a full period.
Medicare.gov’s 2026 worked example: wait two full years (24 months), no Special Enrollment Period, and the penalty is 20% of $202.90, or $40.58. $202.90 + $40.58 = $243.48, rounded to the nearest $0.10, so $243.50 as the 2026 Part B premium in that example.
Generally you will not pay a Part B penalty if you qualify for a Special Enrollment Period (for example, based on current employer coverage meeting Medicare’s rules), or you enroll in a Medicare Savings Program. Confirm the current rule with Medicare.gov or SSA. Calendar detail sits in the enrollment windows and penalties guide and the working past 65 guide. This page is the premium structure, not the full sign-up calendar.
Part A has a different penalty structure if you must *buy* Part A and delay; Part D uses a 1% per uncovered month formula off the $38.99 2026 national base beneficiary premium. Do not mix the three formulas.
Assignment, non-participating providers, and the limiting charge
The 20% coinsurance assumes assignment. Medicare.gov: you get the lowest cost if the doctor or other provider accepts the Medicare-approved amount as payment in full. Participating providers who accept assignment charge only the deductible and coinsurance and must submit the claim to Medicare.
If a provider does not accept assignment, Medicare still pays its share based on the approved amount, but you can be billed more, subject to the limiting charge (generally 15% above the Medicare-approved amount for non-participating providers who still take Medicare patients). Providers who opt out of Medicare entirely are a different case: you typically pay the full private fee under a private contract, and Medicare pays nothing for those services (with narrow exceptions). Ask before the visit: “Do you accept Medicare assignment?”
Facility fees matter too. A Part B service in an outpatient hospital department can mean coinsurance to the doctor and a facility copayment. Ask what setting the service is billed from.
What Part B does not fix by itself
- No annual OOP ceiling on Original Medicare Part A/B alone.
- No routine dental, hearing aids, or eyeglasses (narrow medical exceptions exist for some dental situations; cataract surgery has a limited glasses/contacts rule after IOL implant, confirm Medicare.gov).
- No long-term custodial care (help with bathing, dressing, toileting).
- IRMAA and late penalties ride on top of the standard premium; Advantage does not erase them.
- Medigap can help with Original Medicare cost sharing if you buy it on Path A. It does not cancel the Part B premium. See Medigap vs Medicare Advantage.
A practical checklist when the SSA letter arrives (not advice)
- Read whether the letter is Part B IRMAA, Part D IRMAA, or both.
- Confirm which tax year SSA used (usually two years back).
- Compare the MAGI SSA cites to your return, amended returns and IRS corrections have a SSA path.
- If a listed life-changing event cut your income, review SSA-44 documentation requirements with SSA: do not invent events.
- Budget the total monthly Part B (standard + IRMAA + any late penalty), not just the $202.90 headline.
- Remember Advantage still collects Part B; a $0 plan premium is a separate line item.
Confirm every dollar with SSA and Medicare.gov before you change coverage. Dropping Part B to “avoid IRMAA” can create late-enrollment and coverage gaps that cost more than the surcharge. Get counseling from SHIP or SSA before you act.
FAQ
Do I still pay the Part B premium if I join Medicare Advantage?
Yes. You must keep Part B (and pay its premium, including any IRMAA or late penalty) to stay in Advantage. A $0 plan premium does not replace Part B.
What is IRMAA?
The income-related monthly adjustment amount, an extra amount SSA adds to Part B and/or Part D premiums when MAGI is above published thresholds. It is based on a tax return typically from two years earlier. Live brackets: SSA Medicare premiums.
Can I appeal IRMAA or ask for a new decision after a life event?
Yes, through Social Security. Appeals and life-changing-event requests (SSA-44) are SSA processes. Wrong IRS data is corrected with IRS, then SSA updates. This page is not an appeal form.
Does Original Medicare have a yearly out-of-pocket maximum?
No, not on Part A/B alone. Advantage plans must have a yearly limit on what you pay for covered Medicare services; the dollar amount varies by plan.
What is the 2026 standard Part B premium and deductible?
$202.90 per month standard premium; $283 annual deductible; usual 20% coinsurance after the deductible when the provider accepts assignment (CMS, Nov. 14, 2025).
Which tax year sets my 2026 IRMAA?
Generally tax year 2024 (return filed in 2025). SSA may sometimes use an older year until newer IRS data arrives, the notice states which year it used.
Does IRMAA change my Part B deductible or Medigap needs?
IRMAA changes the premium, not the Part B deductible amount. Deductible and coinsurance rules stay the same. Whether you want Medigap is a separate Original-Medicare path decision; Medigap cannot sit on Advantage.
Should I drop Part B to avoid IRMAA?
Do not treat that as a default strategy. Dropping Part B can mean going without outpatient coverage and risking late-enrollment penalties if you return later. Confirm consequences with Medicare.gov, SSA, or SHIP before any change.
Sources
Every figure above traces to CMS, Medicare.gov, or SSA. We do not cite insurance marketplaces for data. Full IRMAA bracket tables are intentionally linked, not pasted, so they do not go stale on this page. Figures last verified September 22, 2026 (ET).
- CMS: 2026 Medicare Parts A & B Premiums and Deductibles (Nov. 14, 2025)
- SSA: Premiums for higher-income beneficiaries
- Medicare.gov: Avoid late enrollment penalties
- Medicare.gov: 2026 Medicare Costs (Publication 11579)
- Medicare.gov: Medicare & You 2026 (Publication 10050)
- Medicare.gov: What Part B covers
- SSA: Form SSA-44 (IRMAA life-changing event)
- Medicare.gov: Compare Original Medicare & Medicare Advantage
