According to the Social Security Administration (2014b), anyone who is eligible for premium-free part A can enroll in Part B with a monthly premium. If you are not eligible for premium-free Part A, you can receive Part B if you are a U.S. citizen or “a lawfully admitted non-citizen who has lived in the United States for at least five years” (p. 7). Medicare Part B is completely voluntary and not funded by payroll taxes; therefore, enrollees must pay a monthly premium. These premiums are typically deducted from the enrollee’s Social Security check, unless there is a special circumstance (i.e. the beneficiary does not receive Social Security payments or the Social Security payment is lower than the cost of the Part B premium). The premium is determined by the Office of the Actuary each year to cover 25% of Part B costs, while 75% of the costs are paid for through general revenues (Learn about, 2012; SSA, 2013; Van de Water, 2013). These premiums are deposited into the Supplemental Medical Insurance (SMI) Trust Fund, which also receives a small amount of financial from special payments by states and from prescription drug manufacturer fees (Lew et al., 2014).

Original Medicare Part B “helps cover medically necessary doctors’ services, outpatient care, home health services, durable medical equipment, and other medical services” (DHHS, 2014, p. 40). Most preventive services are also covered, including a “wellness screening” once per year. If you have Original Medicare, you are required to pay the Part B deductible, which is $283 per month in 2026. After that, you typically pay 20% of the cost of the service. Wellness visits do not require a deductible or copay. During the first year of having Part B, you can have a “Welcome to Medicare” preventive visit that includes a review of your medical history, as well as education and counseling about preventive services. After that you can receive an annual wellness visit that includes a “Health Risk Assessment”. This visit is only covered once every 12 months (DHHS, 2014).

Beginning in 2023, individuals whose full Medicare coverage ended 36 months after a kidney transplant, and who do not have certain other types of insurance coverage, can elect to continue Part B coverage of immunosuppressive drugs by paying a premium. For 2026, the standard immunosuppressive drug premium is $121.60.

There are a variety of services covered by Part B; however, there is also a lot that is not covered. These health services include most dental care; eye exams related to prescribing glasses; dentures; cosmetic surgery; acupuncture; hearing aids and exams to fit hearing aids; and long-term care (DHHS, 2014). Many people who want these additional services or who want to pay lower deductibles and copays will purchase Medicare Advantage or Medigap.

The income amount used to determine your premium is based on two years earlier. In other words, your 2024 income is used to determine your 2026 re shown below.

Since 2007, a beneficiary’s Part B monthly premium has been based on his or her income. These income-related monthly adjustment amounts affect roughly 8% of people with Medicare Part B. The 2026 Part B total premiums for high-income beneficiaries with full Part B coverage are shown in the following table:

Full Part B Coverage
Beneficiaries who file individual tax returns with modified adjusted gross income:	Beneficiaries who file joint tax returns with modified adjusted gross income:	Income-Related Monthly Adjustment Amount	Total Monthly Premium Amount
Less than or equal to $109,000	Less than or equal to $218,000	$0.00	$202.90
Greater than $109,000 and less than or equal to $137,000	Greater than $218,000 and less than or equal to $274,000	$81.20	$284.10
Greater than $137,000 and less than or equal to $171,000	Greater than $274,000 and less than or equal to $342,000	$202.90	$405.80
Greater than $171,000 and less than or equal to $205,000	Greater than $342,000 and less than or equal to $410,000	$324.60	$527.50
Greater than $205,000 and less than $500,000	Greater than $410,000 and less than $750,000	$446.30	$649.20
Greater than or equal to $500,000	Greater than or equal to $750,000	$487.00	$689.90

The 2026 Part B total premiums for high-income beneficiaries who only have immunosuppressive drug coverage under Part B are shown in the following table:

Part B Immunosuppressive Drug Coverage Only
Beneficiaries who file individual tax returns with modified adjusted gross income:	Beneficiaries who file joint tax returns with modified adjusted gross income:	Income-Related Monthly Adjustment Amount	Total Monthly Premium Amount
Less than or equal to $109,000	Less than or equal to $218,000	$0.00	$121.60
Greater than $109,000 and less than or equal to $137,000	Greater than $218,000 and less than or equal to $274,000	$81.10	$202.70
Greater than $137,000 and less than or equal to $171,000	Greater than $274,000 and less than or equal to $342,000	$202.70	$324.30
Greater than $171,000 and less than or equal to $205,000	Greater than $342,000 and less than or equal to $410,000	$324.30	445.90
Greater than $205,000 and less than $500,000	Greater than $410,000 and less than $750,000	$445.90	$567.50
Greater than or equal to $500,000	Greater than or equal to $750,000	$486.50	$608.10

Premiums for high-income beneficiaries with full Part B coverage who are married and lived with their spouse at any time during the taxable year, but file a separate return, are as follows: 

Full Part B Coverage
Beneficiaries who are married and lived with their spouses at any time during the year, but who file separate tax returns from their spouses with modified adjusted gross income:	Income-Related Monthly Adjustment Amount	Total Monthly Premium Amount
Less than or equal to $109,000	$0.00	$202.90
Greater than $109,000 and less than $391,000	$446.30	$649.20
Greater than or equal to $391,000	$487.00	$689.90

Premiums for high-income beneficiaries with immunosuppressive drug only Part B coverage who are married and lived with their spouse at any time during the taxable year, but file a separate return, are as follows:

Part B Immunosuppressive Drug Coverage Only
Beneficiaries who are married and lived with their spouses at any time during the year, but who file separate tax returns from their spouses with modified adjusted gross income:	Income-Related Monthly Adjustment Amount	Total Monthly Premium Amount
Less than or equal to $109,000	$0.00	$121.60
Greater than $109,000 and less than $391,000	$445.90	$567.50
Greater than or equal to $391,000	$486.50	$608.10