Medicare Part B (Original Medicare) Plans in California

Medicare Part B, often referred to as “Original Medicare,” is the federal government’s medical insurance plan primarily for those aged 65 and older. Part B helps pay for most non-hospital-related care (doctor fees, outpatient care, preventive services, and similar expenses). On this page I’m going to explain what Medicare Part B covers, how it works with other parts of Medicare, what you pay in premiums and out-of-pocket costs, and ways to reduce your Part B costs in California.

This guide is written for people who are new to Medicare, already enrolled, or helping a family member understand their coverage.

Medicare Part B Explained

Original Medicare has different parts that cover different types of care.

• Part A covers hospital insurance (inpatient care)
• Part B covers medical insurance (outpatient care)
• Part D covers prescription drugs

For most people, Part A and Part B work together to cover their care. Part B helps cover services you receive outside of a hospital stay.

Another type of coverage, Medicare Advantage plans (also called Part C), bundles together Part A and Part B, and often Part D. These plans are offered by private insurance companies as an alternative to Original Medicare.

Where You Can Get Care with Part B

If you have Original Medicare, you can see any doctor or clinic in the U.S. that accepts Medicare. There are no network restrictions, which is helpful if you travel or move often.

If you have a Medicare Advantage plan, you must use doctors and clinics in the plan’s network for most Part B services. Emergency care is covered anywhere in the U.S. (and sometimes even internationally), but routine care outside the network may not be covered.

What Medicare Part B Covers in 2026

Part B covers many common healthcare services, including:

• Doctor visits (primary care and specialists)
• Outpatient procedures and surgeries
• Lab tests and imaging (like X-rays and MRIs)
• Mental health services
• Ambulance services (when medically necessary)

With Original Medicare, you can see any doctor or visit any clinic in the U.S. that accepts Medicare without restrictions. With a Medicare Advantage plan, you must see only doctors who are in the plan’s network.

Preventive Services

Part B also covers preventive care to help you stay healthy. Many of these services cost $0 if you meet certain guidelines. Examples include:

• Annual wellness visits
• Screenings (like mammograms and colon cancer tests)
• Vaccines (like flu shots and the shingles vaccine)

Getting these preventive services can help you avoid more costly future doctor visits or even hospitalization for common illnesses like the flu.

Durable Medical Equipment

Part B covers certain medical equipment you use at home, such as:

• Wheelchairs
• Walkers
• Oxygen equipment
• Hospital beds

What Medicare Part B Does Not Cover

Part B does not cover everything. The following services are excluded from Part B coverage:

• Hospital inpatient and hospital services (covered by Part A)
• Hospice care (covered by Part A)
• Skilled nursing facility care (covered by Part A)
• Prescription drug coverage (covered by Part D)
• Dental or vision services

Other parts of Medicare cover these services. Understanding the gaps in Part B coverage is important for planning your overall Medicare strategy.

Medicare Part B Costs in 2026

Part B does not mean free medical care. Part B has five possible main out-of-pocket costs:

• Premiums – These are set by the government and are required monthly.
• Annual deductible – What you pay first each year before Medicare pays anything.
• Coinsurance – Usually 20% of approved costs after the deductible.
• IRMAA surcharges – If you earn above a certain amount, this surcharge is added to your premium.
• Late enrollment penalty – If you do not enroll on time, you might need to pay a penalty.

Unlike many private health insurance plans, there is no cap or maximum yearly limit on your out-of-pocket costs with Original Medicare Part B. This can lead to significant bills over the course of a year.

Monthly Premium

Most people pay the standard Part B premium. Each year, the federal government sets a new standard Part B premium. In 2026, this amount is $202.90 per month. Part B premiums tend to increase slightly over time due to rising healthcare costs. Some Medicare Advantage plans offer a Part B giveback that refunds you for Part B premiums.

Annual Deductible

You pay a yearly deductible ($283 in 2026) before Part B starts paying any of your medical bills or expenses.

Coinsurance

After the deductible, you typically pay 20% of most care costs while Medicare pays 80% of covered costs. This can add up quickly because the 20% applies to most services, including doctor visits, outpatient procedures, and durable medical equipment.

IRMAA (Income-Related Monthly Adjustment Amount)

If you have a higher income, you may pay more for your Part B premium. Your income is based on your tax return from 2 years ago. Use an IRMAA calculator to estimate your surcharge amount.

If your income has dropped due to a major life event (like retirement), you can request a review. You will complete Form SSA-44, provide proof of the life-changing event, and submit everything to Social Security.

Late Enrollment Penalty

If you enroll after the deadline, you may need to pay a monthly penalty. This penalty is permanent and stays with you for as long as you have Part B. Use a Part B penalty calculator to estimate your potential costs.

Other Possible Costs

Even with Part B coverage, you may have additional costs, including:

• Excess charges – If a provider does not accept Medicare assignment, you may pay up to 15% above Medicare’s approved amount.
• Services not fully covered – Some outpatient procedures, lab tests, or screenings may not be fully covered.
• Immunosuppressive drug coverage premiums – For limited situations, like after a transplant.
• Physical therapy or chiropractic services – Only partially covered if Medicare rules apply.
• Certain mental health services – May require coinsurance or copay.

Knowing these costs ahead of time can help you budget for care and avoid surprises.

Not sure how Part B costs fit into your overall Medicare budget? Let us talk through your options.

Medicare Advantage and Part B

Medicare Advantage (Part C) is an alternative to Original Medicare. Private insurance companies offer Medicare Advantage plans that combine Parts A and B (and often Part D).

Even if you enroll in a Medicare Advantage plan, you must still pay your Part B premium. These plans typically have networks you must choose from when selecting your doctor.

However, Medicare Advantage plans have a yearly out-of-pocket maximum, which can help limit your costs for major medical care. This means you will not pay more than the maximum amount listed for your covered care.

Medigap and Part B

If you choose Original Medicare, adding a Medicare Supplement plan (Medigap) can help you manage costs. Private insurance companies offer these optional plans and can help cover your 20% share of Part B coinsurance or copayments. Some plans also help cover excess charges for Part B. Some older plans covered the Part B deductible, but these are no longer offered to new enrollees.

Who Can Sign Up for Part B

Two primary groups of people can sign up for Part B. You can sign up if you fall into one of the following categories:

Turning 65

• If you are 65 or older and a U.S. citizen or legal permanent resident for at least 5 years, you are eligible for Part B.
• You can enroll during your Initial Enrollment Period (IEP): 3 months before your 65th birthday, your birthday month, and 3 months after.

Under 65 with Disabilities or Certain Medical Conditions

• If you receive Social Security Disability Insurance (SSDI) or Railroad Retirement Board (RRB) disability benefits for 24 months, you are automatically eligible for Part B.
• If you have Amyotrophic Lateral Sclerosis (ALS), you are automatically enrolled in Medicare (Part A and Part B) the month your disability benefits begin.
• If you have End-Stage Renal Disease (ESRD), you may qualify for Part B before age 65, even if you do not receive disability benefits. This usually requires enrollment at or near the start of dialysis or transplant.

Enrollment Periods for Part B

If you are already receiving Social Security or RRB benefits at age 65, you are automatically enrolled in Part B.

If you are not receiving Social Security or RRB benefits at 65, you must sign up through the Social Security Administration during these periods:

Premiums may be deducted from your Social Security check, or you can choose to be billed directly or make automatic payments.

Medicare Part B in California

California’s Medicare landscape has some unique features that can significantly affect your Part B costs and coverage. As someone who works exclusively with California Medicare clients, I want to make sure you know about resources that could save you money.

IRMAA and California High Earners

California has a higher cost of living, and many retirees here have income from home sales, retirement accounts, or investment portfolios that can trigger IRMAA surcharges. Your Part B premium could be significantly higher than the standard $202.90 if your income (from 2 years ago) exceeds certain thresholds.

If you recently retired, sold a home, or had a one-time income event that pushed you into a higher IRMAA bracket, you may be able to appeal using Form SSA-44. I have helped many California clients successfully reduce their IRMAA surcharges this way.

Medi-Cal and Medicare Dual Eligibility in California

If you qualify for both Medicare and Medi-Cal (California’s Medicaid program), you may be eligible for programs that help cover Part B costs:

• Qualified Medicare Beneficiary (QMB) – Covers Part B premiums, deductibles, and coinsurance for low-income Medicare beneficiaries.
• Specified Low-Income Medicare Beneficiary (SLMB) – Covers Part B premiums only, for those with income slightly above QMB limits.
• Qualifying Individual (QI) – Covers Part B premiums for those with income slightly above SLMB limits (limited enrollment, first-come basis).

These programs can eliminate or dramatically reduce your monthly Part B premium. Contact your local county social services office or a HICAP counselor to find out if you qualify.

HICAP – California’s Free Medicare Counseling Program

California’s Health Insurance Counseling and Advocacy Program (HICAP) offers free, unbiased Medicare counseling. HICAP counselors can help you understand your Part B coverage, compare Medicare Advantage and Medigap plans, and identify cost-saving programs you may qualify for.

While HICAP is a great free resource, counselors are not licensed insurance agents and cannot enroll you in a plan. For personalized plan recommendations specific to your situation in Southern California, I am happy to help.

Southern California Provider Networks and Part B

In Southern California, most major hospital systems and provider groups accept Original Medicare, which means your Part B coverage is broadly usable. If you are considering a Medicare Advantage plan, pay attention to network size. Some plans in Los Angeles, Orange County, and the Inland Empire have more limited specialist networks than Original Medicare provides.

Have questions about your Part B costs or California-specific options? Reach out for a free consultation.

Part B Cost-Saving Strategies

If you have limited income and ongoing medical needs, doctor visits and related costs can add up quickly. Here are strategies that can help:

• Look Into Assistance Programs – If you are a California Medi-Cal member who is also eligible for Medicare, the Qualified Medicare Beneficiary (QMB) Program can help cover your Medicare Part A premium, Medicare Part B premium, and other Medicare costs like deductibles and copayments.
• Plan Your Income – Because your income affects your Part B premium, manage withdrawals (like from retirement accounts) carefully to help avoid higher IRMAA tiers.
• Compare Your Coverage Options – You may be able to reduce cost sharing by adding a Medigap policy to your Original Medicare plan or switching to a Medicare Advantage plan.
• Use Preventive Services – Take full advantage of free preventive care (vaccines, colonoscopies, annual wellness visits) to prevent illness and potentially higher medical costs later.

Additional Tips for Managing Part B in 2026

• Keep track of yearly changes in premiums and deductibles.
• Confirm your doctors accept Medicare assignment to avoid extra charges.
• Use online tools like Medicare Plan Finder and IRMAA calculators to plan costs.
• Keep records of health expenses and receipts, which can help if you appeal an IRMAA decision or qualify for assistance programs.
• Review your coverage annually during the Medicare Open Enrollment Period (October 15 through December 7) to ensure your plan continues to meet your needs.

Frequently Asked Questions About Medicare Part B

What is the Medicare Part B premium for 2026?

The standard Medicare Part B premium for 2026 is $202.90 per month. Higher-income beneficiaries may pay more due to the IRMAA surcharge. Your actual premium depends on your income from 2024 (two years prior to 2026).

Is Medicare Part B mandatory?

Part B is optional, but most people enroll when they first become eligible. Delaying Part B enrollment without qualifying coverage (like active employer insurance) results in a permanent late enrollment penalty. If you are still working and covered by an employer group health plan, you may be able to delay Part B without penalty.

What is the difference between Part B and Part D?

Part B covers outpatient medical services (doctor visits, lab tests, preventive care, durable medical equipment). Part D covers prescription drugs you take at home. Some drugs administered in a doctor’s office may be covered by Part B rather than Part D.

Does Medicare Part B cover dental or vision?

No. Standard Medicare Part B does not cover routine dental care, dentures, routine eye exams, or eyeglasses. Some Medicare Advantage plans may include these benefits as extras.

What happens if I miss my Part B enrollment window?

If you miss your Initial Enrollment Period and do not have a qualifying Special Enrollment Period, you will need to wait for the General Enrollment Period (January 1 through March 31). You may also face a permanent late enrollment penalty of 10% for each full 12-month period you were eligible but did not enroll.

Can I get help paying for Part B in California?

Yes. Low-income Californians may qualify for programs like QMB, SLMB, or QI that help pay Part B premiums, deductibles, and coinsurance. Contact your county social services office or HICAP for help determining eligibility.

How does Original Medicare Part B compare to Medicare Advantage?

Original Medicare Part B lets you see any Medicare-accepting provider nationwide, but has no out-of-pocket maximum. Medicare Advantage plans often have lower out-of-pocket costs and an annual maximum, but restrict you to a network of providers. The right choice depends on your health needs, budget, and how important provider flexibility is to you.

What does Medicare assignment mean?

When a provider accepts Medicare assignment, they agree to accept Medicare’s approved amount as full payment. If a provider does not accept assignment, they can charge up to 15% more than Medicare’s approved amount (called excess charges). In California, most major providers accept Medicare assignment, but it is worth confirming before your visit.