How 6.7 Million Californians Rely on Part B
For California’s large and diverse Medicare population, Part B is the backbone of day-to-day medical coverage. Whether you’re seeing a specialist at UCSF, getting a wellness visit at a community clinic in Fresno, or picking up diabetic supplies from a Medicare-approved supplier in San Diego, Part B is what makes it possible.
Part B is medical insurance — it covers the services you use most often as a Medicare beneficiary, from routine checkups to emergency ambulance transport.
Everyday Services Covered by Part B
Think of Part B as your outpatient coverage. Here’s what it pays for across California:
- Primary care and specialists: Office visits with any doctor who accepts Medicare assignment — and in California, the vast majority do
- Preventive screenings at no cost: Mammograms, colonoscopies, cardiovascular screenings, diabetes tests, lung cancer screenings, and your Annual Wellness Visit are all covered at $0 when you see an accepting provider
- Outpatient procedures: Same-day surgeries, lab work, diagnostic imaging (X-rays, MRIs, CT scans), and outpatient hospital services
- Behavioral and mental health: Outpatient visits with psychiatrists, psychologists, and licensed clinical social workers — increasingly important as California expands mental health access for seniors
- Home health when medically necessary: Part-time skilled nursing, physical therapy, and occupational therapy in your home
- Medical equipment: Wheelchairs, walkers, oxygen systems, CPAP machines, and glucose monitors from Medicare-approved California suppliers
- Ambulance transport: Ground and air ambulance when other transportation would endanger your health
California’s Telehealth Advantage
Part B covers telehealth visits with your doctor, which is especially valuable for Californians in rural counties like Modoc, Inyo, or Trinity where specialists may be hours away. Post-pandemic rules have expanded telehealth access permanently for many Medicare services.
What Part B Costs in 2026
Part B has three cost components. Every California beneficiary pays these regardless of which county you live in:
| Cost Component | 2026 Amount | How It Works |
|---|---|---|
| Monthly Premium | $202.90 | Deducted from your Social Security check automatically |
| Annual Deductible | $283.00 | You pay this once per year before Part B kicks in |
| Coinsurance | 20% | Your share after the deductible, with no annual cap under Original Medicare |
That 20% coinsurance with no cap is why many Californians pair Original Medicare with a Medigap policy — a single major surgery could mean thousands in coinsurance without it.
Income-Based Premium Adjustments (IRMAA)
About 8% of California’s Medicare beneficiaries earn enough to trigger IRMAA — a surcharge on top of the standard premium. Social Security looks at your tax return from two years ago (your 2024 return determines your 2026 IRMAA).
| Your 2024 Income (Individual) | Filing Jointly | Total Monthly Premium |
|---|---|---|
| $109,000 or below | $218,000 or below | $202.90 |
| $109,001 – $137,000 | $218,001 – $274,000 | $284.10 |
| $137,001 – $171,000 | $274,001 – $342,000 | $405.80 |
| $171,001 – $205,000 | $342,001 – $410,000 | $527.50 |
| $205,001 – $500,000 | $410,001 – $750,000 | $649.20 |
| Above $500,000 | Above $750,000 | $689.90 |
Retired and Income Dropped?
If you recently retired, sold a business, or lost a spouse, you can request a new IRMAA determination using Form SSA-44. Many Californians overpay because they don’t realize they can appeal based on a life-changing event.
Signing Up for Part B in California
If you’re already collecting Social Security when you turn 65, Part B enrollment is automatic. Otherwise, you’ll need to actively sign up during your Initial Enrollment Period — a 7-month window that opens 3 months before your birthday month.
Still working at 65 with employer coverage? California has many large employers (tech companies, the UC system, state government) that offer group health plans. If your employer has 20 or more employees, you can safely delay Part B until that coverage ends — no penalty.
The Late Enrollment Penalty
Miss your enrollment window without qualifying coverage? You’ll pay a 10% surcharge for every 12-month period you were eligible but not enrolled. This penalty is permanent — it stays with you for as long as you have Part B. On a $202.90 premium, even a 2-year gap means paying $243.48/month for life.
Gaps in Part B Coverage
Part B is comprehensive for medical services, but it specifically does not cover:
- Dental work (cleanings, fillings, crowns, dentures)
- Routine vision care (eye exams, glasses, contacts)
- Hearing aids and hearing exam fittings
- Cosmetic procedures
- Long-term custodial nursing home care
- Most prescription drugs (that’s Part D)
- Care received outside the United States
California’s Medicare Advantage plans often bundle dental, vision, and hearing benefits at no extra premium — one reason MA enrollment is growing rapidly in the state. Or, if you qualify for Medi-Cal, you may get dental through Denti-Cal and other benefits that fill these gaps.
Lowering Your Part B Costs
California offers more help than most states for beneficiaries struggling with Part B costs:
- QMB Program: Pays your Part B premium, deductible, and all coinsurance if your income is below ~$1,255/month
- SLMB Program: Pays your Part B premium if your income is below ~$1,502/month
- QI Program: Pays your Part B premium if your income is below ~$1,689/month
Check if you qualify for a California Medicare Savings Program →