What Medicare Covers When You Visit Your Doctor

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

If you have Original Medicare (Part A and Part B), Medicare pays 80 percent of the cost of a doctor visit after you meet your yearly deductible. You pay the remaining 20 percent, plus any amount the doctor charges above Medicare's approved rate — unless your doctor has agreed not to charge more. If you have a Medicare Advantage plan (Part C), your coverage works differently: you typically pay a copay per visit (often $10 to $50) and may have a separate deductible, depending on your plan.

The key word is "accepts Medicare." Not every doctor does. Before you book an appointment, call the office and ask whether they take Medicare. If they do not, you will pay the full bill out of pocket, and Medicare will not reimburse you unless it is a true emergency.

Key Takeaways

Original Medicare covers 80 percent of doctor visits after you pay your yearly Part B deductible; you pay the remaining 20 percent plus any charges above Medicare's approved amount.
Medicare Advantage plans typically charge a copay per visit instead, usually between $10 and $50, depending on your specific plan.
Your doctor must accept Medicare for the coverage to explore; if they do not, you pay the full cost and Medicare does not reimburse.
Telehealth visits with your doctor are covered the same way as in-person visits under both Original Medicare and most Medicare Advantage plans.
Preventive visits — like annual wellness exams and certain screenings — are covered at 100 percent under both Original Medicare and Medicare Advantage with no copay.

How Original Medicare Part B Covers Doctor Visits

Under Original Medicare Part B, your doctor visit is covered after you pay your yearly deductible. For 2024, that deductible is $240, though the amount changes each year. Once you have paid it, Medicare pays 80 percent of what it considers the approved amount for the visit. You pay the other 20 percent.

The catch is the "approved amount." Medicare sets a fee schedule for each type of visit and each region. Your doctor's actual charge may be higher. If your doctor is a participating provider — meaning they have signed an agreement with Medicare — they cannot charge you more than Medicare's approved amount. If your doctor is a non-participating provider, they can charge up to 15 percent more than the approved amount, and you are responsible for that extra cost on top of your 20 percent coinsurance.

You can search for participating doctors on Medicare.gov using the "Care Provider Search" tool, or call your doctor's office directly and ask whether they are a participating provider.

Medicare Advantage Plans and Doctor Visit Costs

If you have a Medicare Advantage plan, the plan itself decides how much you pay for a doctor visit. Most plans charge a copay — a flat fee per visit — rather than a percentage. That copay might be $10, $25, $50, or another amount depending on your plan and whether you see your primary care doctor or a specialist.

Some Medicare Advantage plans also have a yearly deductible you must meet before the plan starts paying. Others do not. Your plan documents and your member ID card will show your copay amounts and whether you have a deductible. If you are not sure, call the plan's customer service number on the back of your card.

One advantage of Medicare Advantage is that your out-of-pocket costs are usually more predictable than under Original Medicare. You know exactly what you will pay per visit. The trade-off is that you must use doctors in your plan's network, except in emergencies or certain other situations.

Preventive Visits Are Covered at No Cost

Both Original Medicare and Medicare Advantage cover certain preventive visits at 100 percent with no copay or coinsurance. These include your annual wellness visit, screenings for cancer and heart disease, and vaccinations like the flu shot and pneumonia vaccine.

To get this coverage, you must see a doctor who accepts Medicare and who is a participating provider (under Original Medicare) or in your plan's network (under Medicare Advantage). The visit must be for a covered preventive service — not for treating an existing condition. If your doctor discovers a problem during a preventive visit and you need follow-up testing or treatment, that follow-up is not considered preventive and will be subject to your regular copay or coinsurance.

Telehealth Visits and Virtual Doctor Appointments

Medicare covers telehealth visits — appointments by video or phone with your doctor — the same way it covers in-person visits. If you have Original Medicare, you pay 20 percent coinsurance after your deductible. If you have Medicare Advantage, you pay your plan's copay.

Your doctor must accept Medicare, and the visit must be for a condition Medicare would cover in person. Not all doctors offer telehealth, so ask your doctor's office whether they do. Some Medicare Advantage plans have restrictions on which telehealth providers they cover, so check your plan documents or call your plan if you want to use a telehealth service outside your doctor's office.

What Happens If Your Doctor Does Not Accept Medicare

If your doctor does not accept Medicare, Medicare will not pay for your visit, and you will owe the full bill. This is true even if you have Original Medicare or a Medicare Advantage plan. The only exception is a true emergency — if you go to an emergency room and the doctor who treats you does not accept Medicare, Medicare may still cover part of the cost.

Before you choose a doctor or schedule an appointment, always confirm that they accept Medicare. You can search for doctors on Medicare.gov, ask your primary care doctor for a referral to someone who accepts Medicare, or call the doctor's office directly. If your current doctor does not accept Medicare and you want to keep seeing them, you would need to pay out of pocket.

How to Find Out What Your Specific Plan Covers

Your coverage details depend on your exact plan, so the best source is your plan documents or your plan's website. If you have Original Medicare, you can call Medicare directly at 1-800-MEDICARE (1-800-633-4227) to ask about a specific doctor or service. If you have Medicare Advantage, call the customer service number on your member ID card.

You can also use the "Care Provider Search" tool on Medicare.gov to look up whether a specific doctor accepts Medicare and what type of provider they are. Write down your doctor's name, location, and specialty before you search, because the tool works best with exact information.

Frequently Asked Questions

Do I have to pay anything if I see my doctor for a preventive visit?

No. Preventive visits like your annual wellness exam and covered screenings are free under both Original Medicare and Medicare Advantage. You pay nothing if you see a participating doctor. If your doctor finds a problem and you need treatment or follow-up testing, that is not considered preventive and you will owe your regular copay or coinsurance.

What if my doctor charges more than Medicare says the visit is worth?

If your doctor is a participating provider, they cannot charge more than Medicare's approved amount. If they are a non-participating provider, they can charge up to 15 percent above the approved amount, and you are responsible for that extra charge. Always ask whether your doctor is a participating provider before your visit.

Does Medicare cover urgent care or walk-in clinic visits?

Yes, if the urgent care center or clinic accepts Medicare. You pay the same way you would for a regular doctor visit — 20 percent coinsurance under Original Medicare (after your deductible), or your plan's copay under Medicare Advantage. Call ahead to confirm they accept Medicare.

Will Medicare pay for a doctor visit if I travel out of state?

Under Original Medicare, yes — any doctor who accepts Medicare can bill Medicare, regardless of where they are located. Under Medicare Advantage, it depends on your plan. Most plans cover emergency or urgent care out of state, but routine visits may not be covered. Check your plan documents or call your plan before traveling.

What if I see a doctor and later find out they do not accept Medicare?

You are responsible for the full bill. Medicare will not reimburse you. This is why it is important to confirm before your appointment that your doctor accepts Medicare. If you have already paid a bill for a visit to a non-participating doctor, you can contact Medicare at 1-800-MEDICARE to ask whether there are any options.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.