Medicare Part B in 2026: What’s Covered, What’s Not, and What Ohio Retirees Pay

Most people we sit down with in Beavercreek understand Part A well enough. It’s the hospital piece, it’s usually free, and it shows up automatically at 65. Part B is where the questions start — and where the surprises land, because Part B is the part you pay for every single month whether you use it or not.

Here’s what Part B pays for in 2026, what it leaves on your kitchen table, and where the real money hides.

What Part B Actually Is

If Part A is the hospital, Part B is everything around it. Medicare describes Part B as covering two categories: medically necessary services, meaning care that meets accepted standards of practice to diagnose or treat a condition, and preventive services meant to catch problems early.

In practice that means your doctor at Premier Health or Kettering Health, your outpatient surgery, your lab work, your ambulance ride, your walker, your oxygen equipment, and your mental health care. It also means the doctor who sees you while you’re admitted as a hospital inpatient — Part A pays for the room, Part B pays for the physician standing next to the bed. That split confuses people constantly, and it’s why a single hospital stay can generate bills from two directions.

What You Pay in 2026

Four numbers do most of the work:

• The 2026 standard Part B premium is $202.90 a month. That’s up $17.90 from $185.00 in 2025. For most people it comes straight out of the Social Security check.
• The 2026 Part B deductible is $283 — up $26 from $257 the year before. You pay it once per calendar year, not per illness.
• After the deductible, you generally pay 20% of the Medicare-approved amount for each covered service.
• There is no annual out-of-pocket maximum. None. That 20% keeps going on a $900 knee scan and on a $90,000 cancer course.

That last point is the one worth reading twice. Original Medicare has no ceiling on what you can spend in a year unless you add a Medicare Supplement (Medigap) policy or join a Medicare Advantage plan. A healthy 68-year-old and a 68-year-old six months into a serious diagnosis pay the same premium and have wildly different exposure.

A few services sit outside the usual 20%. Covered clinical laboratory services cost you $0. Covered home health care services cost you $0, though the durable medical equipment that comes with them still runs 20%. And if you use an insulin pump covered under Part B’s durable medical equipment benefit, a month’s supply of covered insulin can’t cost you more than $35 — the Part B deductible doesn’t apply to it at all. A three-month supply is capped at $35 per month’s supply, so generally no more than $105.

One Procedure, Start to Finish

Numbers on a page are abstract. Here’s how it actually plays out.

Say it’s February, you haven’t used any Part B services yet this year, and you need an outpatient procedure with a Medicare-approved amount of $1,200.

• The first $283 is yours — that’s the annual deductible.
• That leaves $917. Medicare pays 80% of it; you pay 20%, or $183.40.
• Your share: $466.40.

But if that procedure happens in a hospital outpatient department rather than a freestanding doctor’s office, there’s a second bill. You pay a copayment to the hospital on top of the 20%. Medicare caps that hospital copayment at the Part A inpatient hospital deductible, which is $1,736 in 2026 — so it won’t exceed that, but it can be substantial. The identical procedure often costs more in a hospital outpatient setting than in a doctor’s office. That’s not a billing error. That’s how the system is built.

Then March comes and you need something else. The deductible is already met, so now you’re straight into the 20% — forever, with no cap.

What Part B Covers

The list is long, but the categories retirees ask about most often are these: doctor and outpatient services, ambulance transportation, durable medical equipment like wheelchairs, walkers, and hospital beds, oxygen equipment and accessories, a limited set of outpatient prescription drugs, mental health and substance use disorder treatment, and clinical research studies.

Preventive care deserves its own mention. You pay nothing for most preventive services — screenings, many vaccines, certain exams — as long as you get them from a provider who accepts assignment. That’s a real benefit that goes unused every year in the Miami Valley simply because nobody knew it was free.

What Part B Doesn’t Cover

This is the section that changes retirement budgets. Original Medicare does not cover:

• Eye exams for prescription eyeglasses
• Hearing aids, and the exams to fit them
• Most dental care — routine cleanings, fillings, extractions, dentures
• Long-term care
• Routine physical exams
• Cosmetic surgery and massage therapy
• Concierge care, sometimes called retainer-based or direct-care medicine
• Covered services from a provider who has opted out of Medicare entirely, except in an emergency or urgent situation

There is one dental nuance worth knowing. Original Medicare may pay for certain dental services closely tied to specific medical treatment — a heart valve repair or replacement, an organ transplant, cancer-related treatment, or dialysis for end-stage renal disease. If your cardiologist at Kettering says a tooth has to come out before a valve procedure, that’s a different conversation than a routine cleaning.

The way people cover these gaps varies. Some Medicare Advantage plans bundle in dental, vision, or hearing benefits. A Medigap policy doesn’t add those benefits but does cap your medical exposure. Standalone dental and vision policies exist too. There’s no single right answer, and the answer changes depending on which doctors you want to keep.

The Assignment Question Nobody Asks

The 20% coinsurance math above assumes your provider “accepts assignment” — meaning they agree to take the Medicare-approved amount as full payment. Most do. But a provider who doesn’t accept assignment can bill you above that amount, and a provider who has formally opted out of Medicare can bill you for the whole thing.

Before a referral to a specialist you’ve never seen, especially for anything expensive, it’s a five-second phone call: Do you accept Medicare assignment? Ask it. The answer occasionally saves people hundreds of dollars.

Higher Income, Higher Premium

The $202.90 standard premium isn’t what everyone pays. Roughly 8% of people with Part B pay an income-related monthly adjustment amount on top, based on the tax return from two years earlier.

For 2026, the surcharge starts above $109,000 in modified adjusted gross income for an individual filer, or above $218,000 filing jointly. At that first tier the adjustment is $81.20 a month, bringing the total Part B premium to $284.10. It climbs from there, reaching $689.90 a month at the top bracket.

For anyone retiring from Wright-Patterson, GE Aviation, or a practice sale, this matters more than it looks. A one-time event two years ago — a large Roth conversion, a property sale, a pension lump sum — can push you over a bracket line for a single year. The bracket is a cliff, not a ramp: one dollar over and the full surcharge applies.

The Penalty That Never Ends

If you could have signed up for Part B and didn’t, your premium may go up 10% for each full 12-month period you went without it. Wait two full years and you’re looking at a 20% penalty — and you pay it for as long as you have Part B. It doesn’t expire.

There are exceptions. If you qualify for a Special Enrollment Period, generally because you had employer coverage through active employment, you can delay Part B without penalty. Enrolling in a Medicare Savings Program can also relieve it. The trouble is that retiree coverage and COBRA are not the same as active employer coverage for this purpose, and that’s exactly where people get caught.

Filling the Gaps

Part B is solid coverage with two structural holes: no out-of-pocket ceiling, and a list of everyday needs it simply doesn’t touch. How you patch those holes — Medigap, Medicare Advantage, standalone dental and vision, or some combination — depends on your health, your doctors, your budget, and how much financial uncertainty you can live with.

If you’d like to walk through your own numbers with someone local, Medicare & Retirement Solutions Group is right here in Beavercreek and serves families across Greene and Montgomery counties. A consultation is free, and there’s no obligation attached to it — give us a call or reach out through medretiregroup.com and we’ll look at it together.

This article is general educational information, not individualized tax, insurance, or investment advice. Rules and figures change and individual circumstances vary — please confirm details with your plan, or speak with a qualified professional, before acting.