Key Takeaways
-
Medicare Part B covers most outpatient and medically necessary services in 2026, and for many PSHB enrollees it becomes the primary payer once you are eligible and enrolled.
-
Understanding what Part B pays first, what PSHB fills in second, and what costs may still remain helps you avoid surprises and plan your health expenses more confidently.
Understanding Where Medicare Part B Fits Within PSHB
As a Postal Service Health Benefits enrollee, your coverage structure changes once Medicare Part B applies. In 2026, Medicare Part B generally pays first for covered outpatient and professional services when you are enrolled. PSHB coverage then coordinates as secondary coverage, helping reduce or eliminate some out‑of‑pocket costs.
This coordination does not replace PSHB. Instead, it reshapes how claims are paid and how your total costs are shared between Medicare and PSHB.
What Does Medicare Part B Cover In 2026?
Medicare Part B focuses on outpatient care and services that help diagnose, treat, or prevent illness. In 2026, this includes a wide range of medically necessary services.
Key categories covered by Part B include:
-
Doctor and specialist visits
-
Outpatient hospital services
-
Preventive services
-
Durable medical equipment
-
Certain home health services
-
Mental health outpatient care
Part B is designed to handle ongoing medical management rather than inpatient hospital stays, which fall under Part A.
How Do Doctor And Specialist Visits Get Paid?
In 2026, Medicare Part B pays for medically necessary visits with physicians and other qualified health professionals. Once you meet the annual Part B deductible, Medicare generally pays 80 percent of the approved amount for covered services.
PSHB coverage then steps in as secondary coverage. Depending on your plan structure, this may cover some or all of the remaining 20 percent. The result for many enrollees is lower out‑of‑pocket spending for routine and specialist care compared to relying on PSHB alone.
What Happens With Outpatient Hospital Services?
Outpatient hospital care includes services such as observation stays, outpatient surgeries, diagnostic imaging, and lab tests provided without formal inpatient admission.
In 2026:
-
Medicare Part B applies to most outpatient hospital services
-
You must meet the Part B deductible before Medicare pays
-
Medicare typically pays 80 percent of the approved amount
PSHB coordination may help reduce remaining coinsurance amounts, but coverage depends on how secondary benefits are structured.
How Are Preventive Services Handled?
Preventive care is one of the strongest features of Medicare Part B. In 2026, many preventive services are covered at 100 percent of the Medicare‑approved amount when eligibility rules are met.
Common preventive services include:
-
Annual wellness visits
-
Certain screenings
-
Vaccinations covered under Part B
When Medicare pays the full approved amount, there is usually no balance left for PSHB to cover, resulting in no cost to you for these services.
What About Durable Medical Equipment?
Durable medical equipment includes items such as walkers, wheelchairs, oxygen equipment, and other medically necessary devices used at home.
Under Medicare Part B in 2026:
-
Equipment must be medically necessary and prescribed
-
You must meet the Part B deductible
-
Medicare typically pays 80 percent of the approved cost
PSHB coverage may help with remaining coinsurance, depending on coordination rules.
How Does Medicare Part B Handle Mental Health Care?
Outpatient mental health services are covered under Part B in 2026. This includes services such as therapy visits, psychiatric evaluations, and certain treatment programs provided on an outpatient basis.
Medicare applies the standard Part B cost structure:
-
Annual deductible applies
-
Medicare pays about 80 percent of approved charges
PSHB secondary coverage may help reduce remaining costs, supporting access to ongoing mental health care.
What Is Not Covered By Medicare Part B?
Understanding limitations is just as important as understanding coverage. In 2026, Medicare Part B does not cover everything.
Examples of services not covered by Part B include:
-
Routine dental care
-
Routine vision exams
-
Routine hearing exams
-
Long‑term custodial care
For these services, PSHB coverage rules apply without Medicare involvement.
What Are The Key Costs For Medicare Part B In 2026?
Medicare Part B comes with standardized costs set each year.
For 2026:
-
Standard monthly Part B premium applies to most enrollees
-
Annual Part B deductible must be met before coverage begins
-
After the deductible, Medicare generally pays 80 percent of approved amounts
Some individuals may pay higher premiums based on income‑related adjustments, but the core structure remains the same.
How Does Coordination Of Benefits Actually Work?
When Medicare Part B and PSHB work together, claims follow a defined order.
In most cases:
-
Medicare Part B processes the claim first
-
Medicare pays its share based on approved amounts
-
The remaining balance is sent to PSHB
-
PSHB pays according to secondary coverage rules
This coordination helps prevent duplicate payments and reduces unnecessary out‑of‑pocket costs.
Does Enrollment Timing Affect Coverage?
Yes. Enrollment timing matters in 2026.
If you are eligible for Medicare Part B and enroll on time:
-
Medicare pays first for covered services
-
PSHB coordinates smoothly as secondary coverage
If you delay enrollment without creditable coverage:
-
Late enrollment penalties may apply
-
Gaps in primary outpatient coverage can occur
Understanding enrollment windows helps protect both coverage and costs.
How Does Part B Affect Your Overall Health Spending?
Medicare Part B shifts much of your outpatient cost responsibility to Medicare first. This often leads to:
-
Lower cost sharing for physician and outpatient services
-
More predictable cost structure year to year
-
Reduced reliance on PSHB alone for outpatient expenses
However, Part B does not eliminate all costs. Deductibles, coinsurance, and non‑covered services still require planning.
What Should You Focus On When Reviewing Your Coverage?
In 2026, it is important to focus on how Medicare Part B and PSHB interact rather than viewing them separately.
Key review points include:
-
Which services Medicare pays first
-
How PSHB fills coverage gaps
-
What costs remain your responsibility
-
Whether enrollment timing aligns with your eligibility
A clear understanding helps you avoid assumptions and unexpected expenses.
Bringing The Coverage Pieces Together
Medicare Part B plays a central role in outpatient and preventive care for PSHB enrollees in 2026. It pays first for many medically necessary services, while PSHB coverage works in the background to coordinate and supplement those payments.
If you want help reviewing how Medicare Part B fits into your PSHB coverage, consider speaking with one of the licensed agents listed on this website. They can help you understand coordination rules, enrollment timing, and what to expect as coverage continues.
