What does Part B cover?
Part B covers two kinds of services: medically necessary services to diagnose or treat a condition, and preventive services to catch problems early.
- Doctors and other clinicians: office visits, specialists, surgeons, and doctors' services during a hospital stay.
- Outpatient care: emergency room visits, outpatient surgery, observation stays, lab tests, X-rays and imaging.
- Preventive services: the Welcome to Medicare visit, yearly wellness visits, many cancer screenings, flu, COVID-19, pneumonia and hepatitis B shots, and more. Many cost you nothing if your provider accepts assignment.
- Durable medical equipment: walkers, wheelchairs, hospital beds, oxygen and diabetes testing supplies.
- Ambulance rides when other transportation could endanger your health, including air ambulance when ground transport can't get you to care in time.
- Outpatient mental health care, including telehealth visits; Medicare's broader home telehealth rules run through December 31, 2027, which matters in North Carolina's mountain and rural counties.
- Physical, occupational and speech therapy.
- Some drugs given in a doctor's office or clinic, such as many injections and infusions, and insulin used with a pump, which costs no more than $35 for a month's supply.
Part B doesn't cover routine dental care, hearing aids, routine eye exams for glasses, or most prescription drugs you fill at a pharmacy; those go to Part D. See Medicare basics.
What does Part B cost in 2026?
| Cost | 2026 amount |
|---|---|
| Standard monthly premium | $202.90 |
| Yearly deductible | $283 |
| Coinsurance after the deductible | Usually 20% of the Medicare-approved amount |
| Premium with income above $109,000 (single) or $218,000 (joint) | From $284.10 a month (IRMAA) |
Original Medicare has no yearly limit on the 20% you pay. That's why many people add a Medigap policy or choose a Medicare Advantage plan, which has a yearly out-of-pocket limit. IRMAA uses your modified adjusted gross income from 2 years earlier (your 2024 federal tax return for 2026) and can be appealed after a life-changing event such as retirement; try the IRMAA calculator. CMS hadn't published the 2027 Part B amounts as of November 13, 2026; see Medicare costs in 2027.
What does "accepts assignment" mean?
A provider who accepts assignment agrees to take the Medicare-approved amount as full payment. You pay only your deductible and 20% coinsurance. Providers who participate in Medicare but don't accept assignment on a claim can charge up to 15% more (the limiting charge). Ask before your visit. You can look up North Carolina doctors on Medicare's Care Compare.
When should I sign up for Part B?
Most people sign up during their 7-month Initial Enrollment Period around 65. If you already get Social Security, you're enrolled automatically and can decline Part B by following the card's instructions. If you or your spouse are still working with job-based coverage at an employer with 20 or more employees, you can usually delay Part B and sign up later in a special enrollment period with forms CMS-40B and CMS-L564. See working past 65.
Late penalty: if you go without Part B when you could have had it and you didn't have job-based coverage from current work, your premium goes up 10% for each full 12-month period you waited, usually for as long as you have Part B. If you miss your window, the General Enrollment Period runs January 1 to March 31, and coverage starts the month after you sign up. Estimate it with the late enrollment penalty calculator.
COBRA, retiree coverage such as the State Health Plan's retiree coverage, and VA health care don't count as coverage from current work, so they don't let you delay Part B without a penalty.
How do I pay the Part B premium?
If you get Social Security or Railroad Retirement benefits, the premium comes out of your monthly payment. North Carolina covers most public jobs under Social Security (92.7% of state and local government workers in 2023, according to the Congressional Research Service), so most retired North Carolina teachers and public workers who collect Social Security pay this way too. If you don't get those benefits yet, Medicare bills you every 3 months, or every month if you also owe a Part A premium or a Part D IRMAA. You can pay online through your Medicare account, set up Medicare Easy Pay to have it deducted from your bank account, use your bank's online bill pay, or mail a payment. Pay on time: unpaid premiums can end your Part B coverage.
North Carolina retirees, military families and Part B
- State Health Plan retirees (TSERS, CJRS, LRS): Part A and Part B must be in effect to enroll in the Plan's group Medicare Advantage Base Plan or Enhanced Plan. If they aren't, you're placed in the 70/30 Plan. On the 70/30 Plan without Part B, the Plan processes claims as if Part B had paid, so you owe the part Medicare would have paid. Your Part B premium is separate from any Plan premium. See State Health Plan retirees and Medicare.
- LGERS retirees: retiree health coverage, if any, depends on your former city, county or local employer, so ask how it works with Part B before you turn 65.
- Military retirees near Fort Bragg, Camp Lejeune, Seymour Johnson or Cherry Point: TRICARE For Life requires both Part A and Part B, and you pay the Part B premium. See military, veterans and TRICARE in North Carolina.
Help paying Part B in North Carolina
North Carolina calls its Medicare Savings Programs MQB. They are part of NC Medicaid, with income limits set as a share of the federal poverty level (NC Medicaid chart MA-2252, effective April 1, 2026) and resources up to $9,950 (single) or $14,910 (couple):
- MQB-Q (QMB, income up to 100% of the poverty level): pays Part A and Part B premiums, deductibles and coinsurance.
- MQB-B (SLMB, over 100% up to 120%) and MQB-E (QI, over 120% up to 135%): pay the Part B premium.
Anyone approved also gets Extra Help with Part D automatically. Apply online through ePASS or through your county Department of Social Services; the NC Medicaid Contact Center, 1-888-245-0179, can help you find your DSS. See Medicare Savings Programs in North Carolina and the savings programs screener.
Next steps
Sign up for Part B through Social Security at ssa.gov or 1-800-772-1213 (TTY 1-800-325-0778). To review how Medigap or Medicare Advantage would work alongside Part B with plans from the companies they work with, you can request a call from a licensed insurance agent. For other questions, call 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048).
Sources
- Medicare.gov — What Part B covers
- Medicare.gov — Preventive and screening services
- Medicare.gov — Does your provider accept Medicare as full payment?
- CMS — 2026 Medicare Parts A and B premiums and deductibles
- Medicare.gov — Avoid late enrollment penalties
- Medicare.gov — Pay your premiums
- Medicare.gov — Telehealth
- Social Security — Premiums: rules for higher-income beneficiaries (IRMAA)
- Congressional Research Service — Social Security Coverage of State and Local Government Employees (R46961), Table 1
- State Health Plan — Retiring and Medicare presentation, 2026 (Part B and the 70/30 Plan)
- NC Retirement Systems — Health benefit coverage for other retirement systems (LGERS)
- TRICARE — TRICARE For Life
- NC Medicaid — MA-2252 Non-MAGI income and reserve limits (MQB), effective April 1, 2026 (PDF)
- NC Medicaid — How to apply (ePASS and county DSS)
- Medicare.gov — Medicare Savings Programs
Frequently asked questions
How much is Medicare Part B in 2026?
The standard Part B premium is $202.90 a month and the deductible is $283 for the year. People with higher incomes pay more through IRMAA, starting above $109,000 of income for a single filer or $218,000 for a joint return, based on the tax return from 2 years earlier.
Do I have to take Part B?
Part B is voluntary, but if you don't sign up when you're first eligible and don't have job-based coverage from your or your spouse's current work, you'll likely owe a late penalty for as long as you have Part B. The State Health Plan's Medicare Advantage options, TRICARE For Life and Medigap all require you to have Part B.
How do I pay Part B if I don't get Social Security yet?
Medicare sends you a bill, every 3 months if you have only Part B. You can pay online through your Medicare account, sign up for Medicare Easy Pay automatic deductions, use your bank's bill-pay service, or mail a payment. Once your Social Security starts, the premium is usually taken from your check.
What is the Part B late enrollment penalty?
Your monthly premium goes up 10% for each full 12-month period you could have had Part B but didn't, and you usually pay it as long as you have Part B. If you qualified for a special enrollment period because of job-based coverage from current work, there's no penalty.
Can North Carolina help pay my Part B premium?
Yes, if your income and resources are limited. NC Medicaid's MQB programs pay the Part B premium for people with income up to 135% of the federal poverty level, and MQB-Q also pays Medicare deductibles and coinsurance. Apply through ePASS or your county Department of Social Services.
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