Medicare Part B covers doctor visits, outpatient care, and diagnostic tests
Medicare Part B is the medical insurance portion of Original Medicare. It pays for services you receive outside a hospital — mainly visits to doctors' offices, urgent care centers, and outpatient clinics. Part B also covers the tests, imaging, and equipment your doctor orders during those visits.
The program does not cover everything a doctor might recommend. It has specific rules about what it will pay for, how much you pay out of pocket, and which providers you can see. Understanding what Part B actually covers prevents surprises when you receive a bill.
Key Takeaways
- Medicare Part B covers doctor office visits, preventive care, lab tests, X-rays, and outpatient surgery — but only when medically necessary.
- You pay a monthly premium for Part B, a yearly deductible, and then 20 percent of the approved cost for most services after that.
- Part B does not cover routine dental, vision, hearing aids, or long-term care — you need separate coverage or must pay out of pocket for these.
- Your doctor must accept Medicare assignment for you to receive the full Part B benefit; out-of-network providers can charge more.
- Preventive services like annual wellness visits, cancer screenings, and vaccines are covered at no cost to you when you see a participating provider.
What Part B covers: the main categories
Doctor office visits are the foundation of Part B coverage. This includes visits to your primary care doctor, specialists, and other physicians. Part B pays for the visit itself and any routine care the doctor provides during that appointment — blood pressure checks, basic exams, and discussion of your symptoms.
Diagnostic and lab services are covered when your doctor orders them. This includes blood tests, urinalysis, EKGs, and other lab work done in a doctor's office or outpatient lab. X-rays, CT scans, ultrasounds, and MRI scans are covered when medically necessary — meaning your doctor has documented a reason for the test.
Outpatient surgery and procedures fall under Part B when performed in a hospital outpatient department or surgical center. This includes biopsies, cataract removal, joint injections, and many other procedures that do not require an overnight hospital stay. Part B also covers anesthesia and facility costs for these procedures.
Mental health services are covered at the same rate as physical health services. This includes visits to psychiatrists, psychologists, and licensed clinical social workers. Part B covers both individual therapy and group therapy sessions when ordered by a doctor.
Preventive services covered at no cost
Medicare Part B covers certain preventive services without charging you the usual 20 percent coinsurance. You pay nothing for these services when you see a doctor who accepts Medicare.
These include your annual wellness visit (a comprehensive physical and health screening), cancer screenings (mammograms, colonoscopies, Pap tests), cardiovascular screenings, diabetes screenings, bone density tests, and vaccines (flu, pneumonia, shingles, COVID-19). Abdominal aortic aneurysm screening is also covered for men ages 65 to 75 who have ever smoked.
The key requirement is that the service must be preventive — ordered to catch disease early, not to treat a condition you already have. Once a doctor diagnoses a condition, follow-up care for that condition is no longer preventive and you will owe the standard 20 percent coinsurance.
What Part B does not cover
Dental care is not covered by Part B, even routine cleanings and exams. Tooth extraction, root canals, dentures, and dental implants are all your responsibility. You can purchase a separate dental plan or pay out of pocket.
Vision and hearing are largely excluded. Part B does not cover routine eye exams, eyeglasses, contact lenses, or hearing aids. It does cover one pair of eyeglasses or contact lenses after cataract surgery, and it covers certain eye conditions like glaucoma or diabetic retinopathy once diagnosed — but not the routine care to detect them.
Long-term care — nursing home stays, assisted living, or in-home care — is not covered by Part B. Medicare Part A covers some skilled nursing facility care after a hospital stay, but custodial care (help with daily activities) is not covered by any part of Original Medicare.
Routine foot care is not covered unless you have diabetes or a related condition. Nail trimming, callus removal, and other routine podiatry are excluded. Foot care related to a diagnosed condition may be covered.
Cosmetic procedures are never covered, even if a doctor recommends them. Facelifts, Botox, hair removal, and similar services are your responsibility.
How much you pay: premiums, deductibles, and coinsurance
Part B has three layers of cost. First, you pay a monthly premium — the amount varies based on your income, but most people pay between $164 and $560 per month in 2024. If you delay signing up for Part B when you first become may be able to access, you may pay a permanent penalty on top of your premium.
Second, you pay an annual deductible before Part B starts paying. In 2024, this is $240. Once you meet this deductible in a calendar year, Part B begins to share costs with you.
Third, you pay coinsurance — typically 20 percent of the Medicare-approved amount for most services. For example, if Medicare approves $100 for a doctor visit and you have met your deductible, you pay $20 and Part B pays $80. Preventive services have no coinsurance.
These amounts change each year. Check your Part B notice each fall to see what your premium and deductible will be for the coming year.
Providers and the assignment rule
Part B only pays its full amount when you see a doctor who accepts Medicare assignment. This means the doctor has agreed to accept Medicare's approved amount as full payment and will not bill you for the difference.
If your doctor does not accept assignment, they can charge you more than Medicare's approved amount. You will still owe your coinsurance (20 percent of the approved amount), but you may also owe the difference between what the doctor charges and what Medicare approves. This difference can be substantial.
Before scheduling an appointment, ask the doctor's office whether they accept Medicare assignment. You can also search for participating providers on Medicare.gov or call 1-800-MEDICARE.
Frequently Asked Questions
Does Part B cover my prescription medications?
No. Prescription drug coverage is Part D, a separate plan you purchase. Part B does not cover any medications, whether taken at home or injected in a doctor's office. Some medications given during an office visit or outpatient procedure may be covered as part of that service, but the medication itself is not a Part B benefit.
Is physical therapy covered by Part B?
Yes, when ordered by a doctor for a medical condition. Physical therapy in an outpatient setting is covered at the standard 20 percent coinsurance after you meet your deductible. Your doctor must document that the therapy is medically necessary. There are also annual visit limits and other restrictions depending on the type of therapy.
What if my doctor says a test is not medically necessary?
Part B only pays for services deemed medically necessary. If your doctor orders a test but Medicare determines it was not necessary for your condition, you may receive a bill. You have the right to appeal this decision. Ask your doctor to explain why the test is necessary before you proceed.
Does Part B cover telehealth visits?
Yes. Telehealth visits with doctors who accept Medicare are covered at the same rate as in-person visits. You pay your coinsurance and deductible the same way. Not all doctors offer telehealth, so ask your provider whether this option is available.
Can I use Part B outside the United States?
Generally no. Part B coverage is limited to the United States and its territories. If you travel abroad, you will need separate travel insurance or must pay out of pocket for medical care. Some limited exceptions exist for care in Canada or Mexico under specific circumstances.