Medicare covers most doctor visits, but what you pay depends on which part of Medicare you have and whether your doctor accepts Medicare

Medicare Part B covers visits to your doctor's office, urgent care clinics, and emergency rooms. You pay a copay or coinsurance at each visit — usually $15 to $50 for a routine appointment — and Medicare pays the rest of the approved amount. If your doctor does not accept Medicare, you may pay the full bill yourself, though Medicare will still reimburse you part of what it considers a reasonable charge.

If you have a Medicare Advantage plan (Part C) instead of Original Medicare, your coverage works differently. Your plan sets its own copays and deductibles, which may be lower or higher than Original Medicare. You must see doctors in your plan's network, with rare exceptions for emergencies.

What Medicare does not cover: routine physical exams beyond the one free annual wellness visit, most preventive screenings that are not on Medicare's covered list, cosmetic procedures, and most services ordered by doctors who are not enrolled in Medicare.

Key Takeaways

  • Original Medicare Part B covers doctor visits after you meet your yearly deductible, and you pay a copay or coinsurance at each visit.
  • Your doctor must accept Medicare assignment (agree to the Medicare-approved amount) for you to pay only the copay; otherwise you may owe more.
  • Medicare Advantage plans cover doctor visits through their own networks and copay structures, which vary by plan and may be lower than Original Medicare.
  • Medicare covers one free wellness visit per year to establish a baseline and discuss preventive care, separate from sick visits.
  • Telehealth visits with your doctor are covered the same way as in-person visits under both Original Medicare and most Medicare Advantage plans.

How Original Medicare Part B pays for doctor visits

When you have Original Medicare, Part B is the piece that covers doctor visits. You pay a monthly premium for Part B (the standard amount in 2024 is $164.90, though it may be higher if you have higher income). After you meet your yearly Part B deductible ($240 in 2024), Medicare pays 80% of the approved amount for most doctor visits, and you pay 20%.

The approved amount is what Medicare decides a service is worth — not necessarily what your doctor charges. If your doctor accepts Medicare assignment, they agree to accept the approved amount as full payment (except for your copay or coinsurance). If your doctor does not accept assignment, they can charge you up to 15% more than the approved amount, and you are responsible for the difference.

You can check whether a doctor accepts Medicare assignment by calling their office or searching the Medicare provider directory at Medicare.gov. Type in the doctor's name and your state to see their status.

What happens with Medicare Advantage plans

Medicare Advantage (Part C) is an alternative to Original Medicare, offered by private insurance companies that contract with Medicare. Instead of paying 20% coinsurance at each doctor visit, you typically pay a fixed copay — often $10 to $40 depending on the type of visit and your specific plan.

Medicare Advantage plans have networks, meaning you must see doctors who are in-network to get the lower copay. If you see an out-of-network doctor, you may pay much more or the plan may not cover the visit at all, except in emergencies. Some plans allow out-of-network care in limited situations, so check your plan documents or call the plan to ask.

Each Medicare Advantage plan sets its own copays, deductibles, and covered services. Two plans from the same insurance company may have different costs. Before you enroll, compare the plans available to you and look at which doctors are in each network.

The free annual wellness visit

Both Original Medicare and Medicare Advantage cover one wellness visit per year at no cost to you — no copay, no coinsurance, no deductible. This visit is different from a sick visit. During a wellness visit, your doctor reviews your health history, checks your vital signs, and discusses preventive care like screenings and vaccinations you may need.

You must schedule this as a wellness visit, not a sick visit, for it to be free. If you go in with a complaint like knee pain or a cough, your doctor may bill it as a sick visit instead, and you will owe your usual copay or coinsurance. Tell your doctor's office when you call that you want your annual wellness visit.

The wellness visit does not include treatment for a specific problem. If your doctor finds something during the visit that needs follow-up — like high blood pressure or a suspicious mole — that follow-up visit is a separate sick visit and you will pay your usual copay.

When your doctor does not accept Medicare

Some doctors do not accept Medicare at all. If you see a doctor who does not accept Medicare, you pay the full bill upfront. You can then submit the bill to Medicare yourself, and Medicare will reimburse you 80% of what it considers the approved amount (after you meet your deductible). You are responsible for the difference between what the doctor charged and what Medicare approved.

This can be expensive. For example, if a doctor charges $200 for a visit and Medicare's approved amount is $100, Medicare pays you $80 (80% of $100) and you are out of pocket $120 ($100 you do not get reimbursed, plus $20 that is your coinsurance). It is worth calling ahead to confirm whether a doctor accepts Medicare before you make an appointment.

Telehealth visits and remote appointments

Medicare covers video visits with your doctor the same way it covers in-person visits. You pay the same copay or coinsurance, and the same deductible rules explore. Your doctor must be enrolled in Medicare for the visit to be covered.

Telehealth is particularly useful if you have mobility problems, live far from your doctor, or need a quick follow-up. Not all doctors offer video visits, so ask your doctor's office whether they do. If you use a telehealth platform like Teladoc or Doctor on Demand, check whether the doctors on that platform accept Medicare before you book.

Specialist visits and referrals

Medicare covers visits to specialists — cardiologists, rheumatologists, orthopedic surgeons, and others — under the same rules as primary care visits. You do not need a referral from your primary care doctor to see a specialist with Original Medicare. You pay your copay or coinsurance the same way.

With Medicare Advantage, you may need a referral from your primary care doctor to see a specialist, depending on your plan. Check your plan documents or call your plan to ask. Specialists must be in your plan's network for you to pay the lower copay.

What is not covered

Medicare does not cover routine physical exams beyond your one free annual wellness visit. If you want a second physical exam in the same year — for example, before surgery or for a job — you pay out of pocket.

Medicare also does not cover most preventive services that are not on its covered list. For example, Medicare covers colonoscopy for colorectal cancer screening but not routine sigmoidoscopy. It covers mammography for breast cancer screening but not routine ultrasound. Ask your doctor which screenings Medicare covers before you schedule.

Cosmetic procedures, experimental treatments, and services ordered by doctors who are not enrolled in Medicare are not covered. If your doctor recommends something you are unsure about, ask whether Medicare covers it before you proceed.

Frequently Asked Questions

Do I have to pay my deductible every year?

Yes. The Part B deductible resets on January 1 each year. Once you meet it, Medicare pays 80% of approved charges for the rest of the year. The deductible amount changes each year — it was $240 in 2024 but may be different in 2025.

What if my doctor charges more than Medicare approves?

If your doctor accepts Medicare assignment, they cannot charge you more than your copay or coinsurance. If your doctor does not accept assignment, they can charge up to 15% above the approved amount, and you owe the difference. Always ask whether your doctor accepts assignment before your visit.

Can I use my Medicare Advantage plan to see any doctor?

You should see doctors in your plan's network to pay the lower copay. Out-of-network doctors may charge you much more or not be covered at all, except in emergencies. Check your plan's provider directory or call the plan to confirm a doctor is in-network before you schedule.

Does Medicare cover urgent care visits?

Yes. Urgent care visits are covered under Part B the same way as doctor's office visits. You pay your copay or coinsurance after you meet your deductible. Make sure the urgent care clinic accepts Medicare before you go.

What should I bring to my doctor's appointment?

Bring your Medicare card and any other insurance cards you have. Bring a list of your current medications and any recent test results. If it is your annual wellness visit, bring a list of any health concerns you want to discuss, even if they are not urgent.