Part Three: What Medicare Part B Does Not Cover
Part B covers outpatient care—doctor visits, lab tests, preventive services, and medically necessary equipment. In 2026, the standard Part B premium is $185.00 per month, though higher earners pay more through IRMAA (Income-Related Monthly Adjustment Amount) surcharges. But even with Part B, there are substantial gaps.
The Part B Deductible and Coinsurance
Many retirees are surprised to learn that even when Part B covers a service, it does not cover all of it. After meeting your annual deductible of $257 in 2026, Medicare Part B typically pays 80% of the approved amount. You are responsible for the remaining 20%, with no out-of-pocket maximum under Original Medicare alone.
No Out-of-Pocket Maximum Under Original Medicare: One of the most alarming features of Original Medicare (Parts A and B without supplemental coverage) is that there is no cap on what you could owe in a single year. If you face a serious illness requiring multiple hospitalizations, specialist visits, and outpatient treatments, your 20% coinsurance responsibility could reach tens of thousands of dollars. This is the primary reason financial advisors strongly recommend Medigap (Medicare Supplement Insurance) for most retirees.
Other Part B Gaps
- Routine dental, vision, and hearing (same as Part A)
- Cosmetic procedures and surgery
- Most prescription medications taken at home
- Medical care received outside the United States (with very narrow exceptions)
- Acupuncture (except for chronic low back pain under certain conditions)
- Long-term care in nursing homes or assisted living facilities
- Routine foot care (except for diabetes-related conditions)
