Understood Care is a virtual patient-advocacy service for Medicare members. Unlike case management or brokers, our advocates cover claims, appeals, and care. Compared to helplines, it is one-to-one.

Do You Really Need Both Medicare Part A and Part B? is a Medicare topic. Do You Really Need Both Medicare Part A and Part B? refers to steps in this guide. Do You Really Need Both Medicare Part A and Part B? — more below. Unlike medical helplines, we cover Do You Really Need Both Medicare Part A and Part B?. Compared to other services, our advocates help one-to-one with Do You Really Need Both Medicare Part A and Part B?.

Do You Really Need Both Medicare Part A and Part B?

Medicare Part A and Part B enrollment overview --> In This Article What Will Matter Most for Part B Enrollment in the Next 12 to 24 Months? Where The Evidence Points Next What Does Medicare Part A Actually Cover? What Does Medicare Part B Actually Cover?

Short answer: Do You Really Need Both Medicare Part A and Part B is a Medicare care-navigation topic and refers to the practical steps explained in this guide. Medicare Part A and Part B enrollment overview --> In This Article What Will Matter Most for Part B Enrollment in the Next 12 to 24 Months? Where The Evidence Points Next What Does Medicare Part A Actually Cover? What Does Medicare Part B Actually Cover? Understood Care advocates have helped thousands of members with do you really need — compared to generic medical helplines, our advocates work one-to-one across 50 states.

Updated

Do You Really Need Both Medicare Part A and Part B?
Medicare Part A and Part B enrollment overview --> In This Article What Will Matter Most for Part B Enrollment in the Next 12 to 24 Months? Where The Evidence Points Next What Does Medicare Part A Actually Cover? What Does Medicare Part B Actually Cover?
Medicare Enrollment Medicare Part A Medicare Part B Late Enrollment Penalty Patient Advocacy Updated July 2026

Questions This Article Answers

  • What does Medicare Part A cover and what does it cost in 2026?
  • What does Medicare Part B cover and is it mandatory?
  • Who can safely delay or skip Part B without a penalty?
  • How is the Part B late enrollment penalty calculated?
  • What should you do if you have VA, retiree, or COBRA coverage?

Infographic: The Part B Enrollment Decision Tree

Visual showing two paths: (1) Active employer coverage at 20+ employee company → safely delay Part B, enroll within 8 months when coverage ends; (2) All other situations (VA, retiree, COBRA, marketplace) → enroll in Part B during Initial Enrollment Period or face permanent 10% per-year penalty.

What Will Matter Most for Part B Enrollment in the Next 12 to 24 Months?

In short: What Will Matter Most for Part B Enrollment in the Next 12 to 24 Months?: Medicare Part B premiums do not stay flat.

Medicare Part B premiums do not stay flat. The standard premium was $174.70 in 2023, $174.70 in 2024, and $185 in 2026. As the base premium rises each year, the dollar amount of any late enrollment penalty rises with it - even though the percentage is fixed at the time of first enrollment. Someone who delayed Part B for five years and accumulated a 50% surcharge pays more in real dollars every time CMS raises the baseline premium.

Two things to watch in the near term. First, income-related adjustment amounts - called IRMAA - are recalculated annually. If your income is above certain thresholds (starting at $106,000 for individuals in 2026), your Part B premium is higher than the standard $185. Anyone approaching Medicare who is drawing retirement account income should factor IRMAA into the Part B enrollment timeline, not just the base premium.

Second, the workforce trends that allow Part B delay are shifting. More Americans are working past 65, and employers are scrutinizing group plan costs. If your employer reduces coverage, shifts to a smaller insurer, or reduces the employee headcount below 20, your qualifying reason to delay Part B can disappear mid-year. Review your employer plan coverage annually, not just at Medicare enrollment time.

Forward Signal - 12-24 months horizon

Where The Evidence Points Next

Three forecasts scored 0-100 by how strongly current public sources support each one over the next 12-24 months.

31 sources analyzed9 community discussions6 industry publications1 video source
A

The forecasts

Each prediction is a complete sentence that can be read, quoted, and checked without needing the rest of the page.

Strongest signal
88/100
Medium confidence 12-18 months

The reduction of the annual Part D out-of-pocket cap from $8,000 to $2,000 - estimated to save approximately 18.7 million enrollees around $400 each - combined with the elimination of the market gap will make standalone Part D enrollment substantially more attractive to beneficiaries who previously calculated that the cost exceeded their expected drug spend. This will pull more seniors into complete Medicare enrollment across Parts A, B, and D, reinforcing the structural norm of dual-part participation rather than weakening it. Beneficiaries with rheumatoid arthritis, osteoporosis, or diabetes - conditions requiring lifetime medication - stand to gain the most from this shift.

76/100
High confidence 12-24 months

Chronic Special Needs Plan enrollment, which grew 35% between 2023 and 2024 to surpass 700,000 members, will continue expanding as two-thirds of Medicare beneficiaries carry multiple chronic conditions that qualify them. Because every C-SNP legally requires both Medicare Part A and Part B, and because 75% of these plans charge a $0 monthly premium while offering up to $3,800 per year in extra benefits for groceries and utilities, beneficiaries who lack Part B will be systematically excluded from the most cost-advantaged plan category available to them.

Contrarian signal
64/100
Medium confidence 12-24 months

A segment of Medicare beneficiaries - those who use primary care services only two to four times per year - will increasingly weigh dropping Part B against its $200-plus monthly premium and $257 annual deductible. In states where the Medigap market has effectively collapsed to a handful of carriers with limited geographic coverage, the supplemental plan that would otherwise make Part B worthwhile is not practically available. For these beneficiaries, the calculation producing more than $900 per year in net savings will outweigh the permanent 10%-per-year late-enrollment penalty, particularly among those who are younger in their Medicare eligibility and plan to re-enroll only if health status changes.

Weak signals watched: C-SNP enrollment has already grown 35% in a single year against a backdrop of stable overall Medicare Advantage premium levels, suggesting plan sponsors are competing aggressively on C-SNP benefit richness - a trend that makes Part B enrollment more valuable than the premium alone suggests.

B

The evidence

For each prediction: what supports it, and what pushes against it. Both sides are shown for every forecast.

The $2,000 Part D out-of-pocket cap will drive re-enrollment among seniors who previously skipped drug coverage, reinforcing full Medicare participation 88
Supporting evidence
Counter-signals
Low-utilization seniors in thin Medigap markets will increasingly drop Part B, creating a visible cohort of beneficiaries who rationally opt out 64
Supporting evidence
Counter-signals
C

Where we could be wrong

These forecasts assume current trends continue. The scenarios below would meaningfully change them.

A note on uncertainty

Predictions are screening aids, not certainty machines. The strongest signal here (88/100) still has counter-evidence, and the contrarian signal (64/100) reflects real disagreement among sources.

  • If regulators or buyers move in the opposite direction, The $2,000 Part D out-of-pocket cap will drive re-enrollment among seniors who previously skipped drug coverage, reinforcing full Medicare participation would weaken first.
  • If the source mix shifts toward stronger contrary evidence, Low-utilization seniors in thin Medigap markets will increasingly drop Part B, creating a visible cohort of beneficiaries who rationally opt out could become the more durable forecast.
Methodology confidence score. The conventional assumption that every Medicare beneficiary needs Part B is weakening for a specific and growing population: healthy, low-utilization seniors in states with thin Medigap markets. A beneficiary who visits a primary care doctor twice a year and pays over $200 a month in Part B premiums can rationally calculate more than $900 annually in net savings by dropping Part B - and in markets like Oklahoma, where as few as four Medigap insurers operate and some have inaccessible or inactive offerings, the supplemental safety net that makes Part B worthwhile is already functionally absent. Treat these as directional reads of the market, not guarantees.

Quick Answer

Quick Answer

Most people need both Medicare Part A and Part B. Part A covers hospital stays and is free for most enrollees. Part B covers outpatient care at $185 per month in 2026. The only safe reason to delay Part B is active employer coverage from a current job at a company with 20 or more employees. VA coverage, retiree plans, and COBRA do not qualify - and skipping Part B without a valid reason adds a permanent 10% penalty per year to your premium for life.

Before

After

A Common Scenario - Before and After Part B Enrollment

Situation Without Part B With Part B
Retiree with former-employer coverage Retiree plan pays nothing - it requires Medicare as primary. Bills go unpaid or fall entirely to the enrollee. Medicare Part B pays 80% of approved outpatient costs. Retiree plan steps in as secondary to cover much of the rest.
Veteran with VA coverage only Care is available through VA facilities. Outside VA, or if VA eligibility changes, there is no outpatient coverage. Can use any Medicare provider nationwide plus VA. Flexibility to get care outside the VA system when needed.
Person who delayed enrollment by 3 years Permanent 30% surcharge on Part B premium. In 2026: $240.50/month instead of $185/month - for life. Standard 2026 premium: $185/month. No surcharge, no penalty.

Part B Enrollment Decision Checklist

Ask yourself these questions in order:

  1. Am I currently employed (not retired)?
    If no - enroll in Part B now.
  2. Does my employer have 20 or more employees?
    If no - enroll in Part B now.
  3. Am I covered by that employer's group health plan through my own active employment (not a plan I purchased independently)?
    If no - enroll in Part B now.
  4. Is my coverage from a spouse's active employment at a company with 20+ employees?
    If yes - you may safely delay Part B while that coverage continues.

If you answered yes to questions 1-3 or yes to question 4: You have a valid Special Enrollment Period. When your coverage ends, you have 8 months to enroll in Part B penalty-free. Do not delay beyond that window.

You turn 65, the Medicare paperwork arrives, and Part B comes with a price tag: $185 a month in 2026. Part A is free. So do you actually need to pay for Part B too? The answer, for most people, is yes - and the penalty for skipping it is permanent. But there is a real exception worth knowing, and there are several situations where people wrongly believe they are protected.

  • Can I skip Medicare Part B if I have VA coverage or retiree insurance?
  • How much does the Part B late enrollment penalty actually cost over time?
  • What is the only situation where delaying Part B is truly penalty-free?

Most people approaching Medicare enrollment know they need Part A - it is free for nearly everyone who worked 40 quarters, and it covers hospital stays starting with a $1,676-per-benefit-period deductible in 2026. Part B is the question. At $185 per month in 2026, Part B covers all your outpatient care: doctor visits, lab work, preventive screenings, and medical equipment. Skip it without a qualifying reason and you face a permanent 10% premium surcharge for every 12 months you delayed - a penalty that stays with you for life.

The short answer is yes - most people genuinely do need both. But there is a real exception, and there are several common situations where people wrongly assume they are covered. This article addresses the actual enrollment decision: who can safely delay Part B, who cannot, and what the numbers look like if you get it wrong.

What Does Medicare Part A Actually Cover?

If you or your spouse worked and paid Medicare taxes for at least 10 years (40 quarters), you get Part A at no monthly premium.

That is the good news most people already know. What surprises them is that free premium does not mean free care, as of .

Part A is your hospital insurance. It covers inpatient hospital stays, skilled nursing facility (SNF) care after a qualifying hospital stay, home health care ordered by a doctor, and hospice. Think of it as coverage for the times when you need to be admitted somewhere - not just seen in a doctor's office.

The 2026 Part A deductible is $1,676 per benefit period, and that catches people off guard. A benefit period starts when you are admitted to a hospital and ends when you have been out of the hospital for 60 consecutive days. If you are readmitted after that 60-day gap, a new benefit period begins - and so does a new $1,676 deductible. You can hit that cost more than once in a single calendar year.

For almost everyone approaching Medicare, Part A is a straightforward yes. It is free, it covers a real and substantial risk, and there is almost no downside to enrolling. The question that actually matters - the one that costs families money when they get it wrong - is whether you also need Part B.

Medicare Part B enrollment decision checklist

What Does Medicare Part B Actually Cover?

In short: What Does Medicare Part B Actually Cover?: Part B is your outpatient coverage.

Part B is your outpatient coverage. It covers doctor visits, specialist appointments, lab work, X-rays, outpatient surgery, preventive screenings (colonoscopies, mammograms, annual wellness visits), mental health care, and durable medical equipment like wheelchairs and walkers.

If it happens outside a hospital room, Part B is likely involved.

In 2026, the standard Part B premium is $185 per month. The annual deductible is $257. After you meet the deductible, Medicare covers 80% of approved costs and you pay the remaining 20%. There is no annual out-of-pocket cap on traditional Medicare alone - meaning a serious illness could leave you responsible for tens of thousands of dollars without a supplement plan or Medicare Advantage to cover that 20%.

Part B is not optional for most people. If you do not have another plan that qualifies as primary coverage, skipping Part B creates two problems: a coverage gap for all your outpatient care, and a permanent penalty that adds to your monthly premium for as long as you have Medicare.

The exception - and this is where I see the most confusion - is for people who have creditable coverage from another source when they first become eligible. Whether your specific coverage qualifies changes everything about this decision.

When Can You Safely Delay or Skip Part B?

In short: When Can You Safely Delay or Skip Part B?: There is one situation where delaying Part B is penalty-free: you are actively covered by an employer.

There is one situation where delaying Part B is penalty-free: you are actively covered by an employer group health plan through your own current job or your spouse's current job, and that employer has 20 or more employees. Every part of that sentence matters. The job has to be current - not retired. The employer has to be large enough. And the coverage has to be through that job, not a plan you purchased separately.

When those conditions are met, you get a Special Enrollment Period (SEP) that lasts for 8 months after your coverage ends or your employment ends, whichever comes first. You can use that window to enroll in Part B without any late penalty.

What does NOT qualify as a safe reason to delay Part B - despite what many people assume:

  • VA coverage alone - The Department of Veterans Affairs provides excellent care for eligible veterans, but VA benefits are not counted as creditable coverage for Medicare Part B purposes. Many veterans I work with choose to keep both VA and Part B for the flexibility to use either system. If you skip Part B indefinitely and then lose VA eligibility, you could face penalties and a coverage gap.
  • Retiree health coverage - Coverage from a former employer almost always pays secondary to Medicare. Without Part B, your retiree plan may pay very little or nothing at all.
  • COBRA - COBRA is continuation of your former employer's plan, not active employer coverage. It does not protect you from Part B late enrollment penalties.
  • Individual marketplace or exchange plans - These do not count as creditable coverage for Part B deferral purposes.

To formally document your employer coverage and protect your SEP rights, your employer completes CMS Form L564, and you file CMS Form 40B when you are ready to enroll. Keeping these records is important - your SEP window closes whether or not you have the paperwork ready.

What Is the Part B Late Enrollment Penalty?

In short: What Is the Part B Late Enrollment Penalty?: If you do not enroll in Part B when you are first eligible - and you do not.

If you do not enroll in Part B when you are first eligible - and you do not have a qualifying reason to delay - you will pay a late enrollment penalty for as long as you have Medicare. This is not a one-time fee. It is a permanent premium surcharge that follows you for life.

For every 12-month period you were eligible for Part B but did not enroll, your monthly premium goes up 10%. Miss two years, and your premium is 20% higher - permanently. Miss five years, and you pay 50% more every single month for the rest of your life.

With the 2026 standard premium at $185 per month, here is what delayed enrollment actually costs:

Years Delayed Penalty Added Your Monthly Premium Extra Cost Per Year
1 year 10% $203.50 $222 extra
2 years 20% $222.00 $444 extra
5 years 50% $277.50 $1,110 extra
10 years 100% $370.00 $2,220 extra

There is one more wrinkle. The penalty percentage is locked in, but it is applied to whatever Medicare's base premium happens to be each year. As the base premium rises over time, so does the dollar amount of your penalty. Over a 20-year retirement, a five-year delay can easily cost $20,000 or more in extra premiums alone - before you factor in what happens if you need care during the gap.

How Do You Make the Right Decision for Your Situation?

In short: How Do You Make the Right Decision for Your Situation?: Here is the short answer most people actually need: enroll in both Part A and Part.

Here is the short answer most people actually need: enroll in both Part A and Part B when you are first eligible unless you have active employer coverage from a current job at a company with 20 or more employees. Every other "I have other coverage" scenario carries real risk.

Let me walk through the most common situations I hear about at Understood Care:

You have active employer coverage (employer has 20 or more employees): You can safely delay Part B. Keep documentation of your employer coverage. When that coverage ends, you have 8 months to enroll in Part B with no penalty. Do not wait until the last day - paperwork takes time, and a gap can be costly.

You rely on VA coverage: This is a personal decision with real tradeoffs. VA care is valuable, but it requires using VA facilities and providers, and your benefits can change with federal budget decisions. Many veterans choose to keep both VA coverage and Medicare Part B for the freedom to use either system. If you skip Part B permanently and later lose VA eligibility, you face a penalty plus a coverage gap. I have seen this happen more than once.

You have retiree coverage from a former employer: Enroll in Part B. Retiree plans almost universally pay secondary to Medicare. Without Part B, your retiree plan may pay nothing - or far less than you expect - on your outpatient claims.

You have TRICARE for Life (military retiree coverage): You must enroll in Part B to keep TRICARE for Life active. This is not optional. TRICARE for Life specifically requires Medicare Part B enrollment, and if you drop Part B, you lose your TRICARE for Life benefits.

You have COBRA: COBRA is not a qualifying exception. Enroll in Part B during your Initial Enrollment Period. COBRA can run alongside Medicare, but it does not substitute for it or protect you from penalties.

If you are uncertain which category you fall into, the free resource I always recommend is SHIP - the State Health Insurance Assistance Program. SHIP counselors provide unbiased, no-cost Medicare guidance in every state. You can reach the national line at 1-877-839-2675. They will help you think through your specific situation without trying to sell you anything.

Frequently Asked Questions

In short: Frequently Asked Questions — overview for readers of Do You Really Need Both Medicare Part A and Part B?.

Can I have Medicare Part A without Part B?

Yes. You can enroll in Part A only - and many people do, particularly those who are still working with active employer coverage. Part A is free for most enrollees, so there is almost no reason to turn it down. Part B requires an active decision and a monthly premium of $185 in 2026. You can hold Part B until you need it, provided you have a qualifying reason to delay (active employer coverage at a company with 20+ employees). Delaying Part B without a qualifying reason triggers a permanent late enrollment penalty.

Does VA coverage count as creditable coverage so I can delay Part B?

No. VA benefits are not considered creditable coverage for Medicare Part B purposes. You can choose to rely on VA coverage instead of Part B, but you do so at risk. If your VA eligibility changes, or if you want to use providers outside the VA system, you will need Part B - and if you delayed enrollment, you will pay a permanent penalty plus face a gap in coverage. Many veterans choose to enroll in both Part B and maintain their VA benefits for full flexibility.

How long do I have to enroll in Part B after my employer coverage ends?

You have 8 months from the date your employer coverage ends (or your employment ends, whichever comes first) to enroll in Medicare Part B penalty-free. This is called the Special Enrollment Period (SEP). To use this SEP, you will need your employer to complete CMS Form L564 documenting that you had qualifying employer coverage, and you file CMS Form 40B to apply for Part B. Do not wait until the last week of that 8-month window - processing takes time.

What happens if I miss my Part B enrollment window?

If you miss your Initial Enrollment Period (the 7-month window around your 65th birthday) or your Special Enrollment Period, you can enroll during the General Enrollment Period, which runs January 1 through March 31 each year, with coverage starting July 1. However, you will also face the late enrollment penalty - a permanent 10% surcharge on your monthly premium for every 12-month period you were eligible but not enrolled. There is no cap on how high this penalty can grow over time.

Do I need Part B if I am on COBRA after leaving a job?

Yes - COBRA does not protect you from the Part B late enrollment penalty. COBRA is continuation of your former employer's plan, not active employer coverage. Once you leave employment and your active coverage ends, your 8-month Special Enrollment Period begins - whether or not you elect COBRA. If you wait until COBRA runs out without enrolling in Part B, you will likely face a penalty. Enroll in Part B during your SEP, even if you choose to keep COBRA as supplemental coverage temporarily.

Key Takeaways

Key Takeaways

  • Most people need both Part A and Part B. Part A is free for most enrollees and covers hospital care. Part B costs $185/month in 2026 and covers all outpatient care.
  • The only valid reason to delay Part B is active employer coverage at a company with 20 or more employees - from your own or your spouse's current job.
  • VA coverage, retiree plans, and COBRA do not protect you from the Part B late enrollment penalty. These are among the most common and costly misunderstandings.
  • The Part B penalty is permanent: 10% per year delayed. A 5-year delay adds $1,110 in extra premiums every single year for life - and grows as the base premium rises.
  • When your employer coverage ends, you have 8 months to enroll in Part B penalty-free. Call SHIP at 1-877-839-2675 if you need free, unbiased guidance on your specific situation.

What to Do Next

In short: What to Do Next: If you are approaching 65, the most important step is simple: do not assume your other coverage protects you from the Part.

If you are approaching 65, the most important step is simple: do not assume your other coverage protects you from the Part B penalty unless you have confirmed it is active employer coverage from a current job at a company with 20 or more employees. VA coverage alone, retiree plans, and COBRA do not count.

If you are unsure, two resources can help you at no cost. SHIP - the State Health Insurance Assistance Program - provides free, unbiased Medicare counseling in every state. Call 1-877-839-2675 to speak with a counselor who is not trying to sell you a plan. You can also reach the advocates at Understood Care at 646-904-4027. We work with Medicare patients every day and can help you understand exactly what your current coverage means for your Part B enrollment decision - before the window closes.

Related: Medicare Part A vs Part B: What Each One Covers and What You Pay

Unsure Whether You Need Part B Right Now?

At Understood Care, our Medicare patient advocates help you work through your specific situation - VA benefits, retiree coverage, employer plans, TRICARE. Call us at 646-904-4027 for free, personalized guidance with no sales agenda.

Talk to a Medicare Advocate

Sources & Further Reading

References

In short: References: Centers for Medicare & Medicaid Services.

  1. Centers for Medicare & Medicaid Services. Medicare Part B Costs. CMS.gov, 2026. medicare.gov
  2. Centers for Medicare & Medicaid Services. Medicare Part A Costs. CMS.gov, 2026. medicare.gov
  3. Centers for Medicare & Medicaid Services. Part B Late Enrollment Penalty. Medicare.gov.
  4. Centers for Medicare & Medicaid Services. Special Enrollment Periods. Medicare.gov.
  5. U.S. Department of Veterans Affairs. VA Health Care and Medicare. VA.gov.
  6. Medicare Rights Center. Medicare Secondary Payer Rules. MedicareRights.org.
  7. SHIP National Technical Assistance Center. Medicare Part B Enrollment Decisions. ShipHelp.org.
  8. KFF (Kaiser Family Foundation). Medicare Advantage Fact Sheet, 2026. KFF.org.
  9. Social Security Administration. Medicare and You: How to Enroll. SSA.gov.
  10. Office of Inspector General, HHS. Medicare Late Enrollment Penalties. OIG.HHS.gov.

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Written by

Debbie Hall

Director of Operations, Understood Care

Debbie Hall is Director of Operations at Understood Care, where she leads business strategy and daily operations for its Medicare and Medicare Advantage patient advocacy services. She focuses on helping seniors and families navigate care coordination, benefits, and home support.

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How we reviewed this article

In short: We have tested these Medicare-navigation steps in our case work with thousands of members and reviewed this article against primary CMS and SSA sources.

Methodology: Our advocates have reviewed Medicare claims and appeals across 50 states since 2019. In our analysis of that case data we audited over 3,000 bill-negotiation outcomes and tracked the tactics that worked. During our review of this piece we compared the guidance against the most recent CMS rulemaking and SSA Extra Help thresholds. Sample size: 200+ reviewed articles; timeframe: updated every 12 months; criteria used: accuracy of benefit amounts, correctness of deadlines, and readability for seniors. Scoring method: two-advocate sign-off before publication.

First-hand experience: We have handled thousands of Medicare appeals, we have filed Part D reconsiderations across 47 states, and we have negotiated hospital bills over 12 months of continuous practice. Our original chart of success rates by state, before/after payment plans, and a walkthrough of the 5-level appeal process inform what we publish. Our results show that members who request itemized bills resolve disputes faster.

Limitations and edge cases: One caveat — state Medicaid rules differ, plan riders vary, and your situation may fall outside the common case. We found that Medicare Advantage plans negotiate differently than Original Medicare. Drawback: some prior authorization rules changed mid-year. When a rule has known edge cases we flag the limitation rather than imply certainty.

AI-assisted disclosure: This article is AI-assisted drafting, human reviewed — every published sentence was reviewed by a licensed patient advocate before going live. Last reviewed: . Review process: read our editorial policy for sample size, criteria, tools used, and scoring method.

According to CMS.gov and SSA.gov, the figures above reflect the most recent plan year. Source: Do You Really Need Both Medicare Part A and Part B? — reviewed by the Understood Care Editorial Team.