Medicare Part B covers doctor visits, outpatient care, and medical equipment — but not everything
Medicare Part B is the insurance that pays for services from doctors and other providers outside a hospital. It covers office visits, lab tests, X-rays, ambulance rides, and durable medical equipment like wheelchairs and oxygen. It does not cover dental work, vision care, hearing aids, or most prescription drugs — those need separate coverage or out-of-pocket payment.
Part B is optional, but most people who have Part A (hospital insurance) also enroll in Part B. You pay a monthly premium for Part B, and then Medicare pays its share of covered services after you meet your deductible. The amount you pay depends on your income; higher earners pay more.
Key Takeaways
- Part B covers doctor office visits, lab work, imaging, outpatient surgery, and preventive care screenings at no cost to you.
- Part B does not cover dental, vision, hearing aids, or most prescription drugs — you need separate plans or must pay out of pocket.
- You typically pay a monthly premium, an annual deductible, and then 20 percent of the cost for most services after Medicare pays its share.
- Some services require prior approval from Medicare before you receive them, or Medicare will not pay.
- Urgent care centers and walk-in clinics are covered under Part B if they are Medicare-enrolled providers.
What Part B covers: doctor visits and outpatient services
Part B pays for visits to your primary care doctor, specialists, and other providers like nurse practitioners and physician assistants. It covers the full cost of preventive care visits — annual wellness exams, cancer screenings, diabetes tests, and cardiovascular risk assessments — with no deductible or copay. Once you need treatment for a condition, you pay your deductible first, then 20 percent of the cost.
Outpatient services covered by Part B include lab tests, blood work, X-rays, ultrasounds, CT scans, and EKGs. Part B also covers outpatient surgery at hospitals or surgical centers, mental health counseling, physical therapy, occupational therapy, and speech therapy. If you receive these services in a hospital outpatient department, you may pay more than you would at a doctor's office because hospital facility fees explore.
Ambulance rides to a hospital or skilled nursing facility are covered if medically necessary. Durable medical equipment — wheelchairs, walkers, oxygen tanks, CPAP machines, and hospital beds — is covered at 80 percent after you meet your deductible, though Medicare must determine the equipment is medically necessary first.
What Part B does not cover
Dental care is not covered by Part B, even for tooth extraction or root canals. Vision care — eye exams, glasses, and contact lenses — is not covered, though Part B does cover eye exams for glaucoma screening and cataract surgery. Hearing aids and hearing exams are not covered by Part B; you must purchase them separately or through a supplemental plan.
Most prescription drugs are not covered by Part B. Drugs you take at home are covered under Part D (prescription drug coverage), which is a separate plan you enroll in. Some drugs given by injection in a doctor's office or hospital outpatient setting are covered by Part B, such as certain cancer medications and biologics, but you need to check with your provider first.
Routine foot care, cosmetic surgery, weight loss programs, and acupuncture are not covered. Long-term care in a nursing home or assisted living is not covered by Part B; you would need to pay out of pocket or have a separate long-term care plan. Experimental treatments and procedures not yet approved by the FDA are not covered.
How much you pay: premiums, deductibles, and copays
The standard Part B monthly premium in 2024 is $164.90 for most people, though it varies by income. If you earn more than $97,000 as a single filer or $194,000 as a married couple filing jointly, you pay a higher premium called an Income-Related Monthly Adjustment Amount (IRMAA). The higher your income, the more you pay — up to $560.50 per month for the highest earners.
The annual Part B deductible is $240 in 2024. Once you meet this deductible, Medicare pays 80 percent of the cost for most covered services, and you pay 20 percent. For preventive care with no diagnosis code — like a wellness visit or cancer screening — you pay nothing after you enroll in Part B.
If you see an out-of-network provider who does not accept Medicare, you may pay the full cost and receive no reimbursement. Always check that your doctor accepts Medicare assignment before your visit.
Services that need prior approval from Medicare
Some services require prior authorization — Medicare must approve them before you receive them, or the agency will not pay. These include certain imaging tests, mental health treatment beyond a set number of visits per year, and some surgeries. Your doctor's office usually handles the authorization request, but you should ask whether your procedure needs approval before your appointment.
If you receive a service without prior approval and Medicare denies it, you may receive a bill for the full cost. Ask your provider to check with Medicare first, and request a written estimate of what you will owe if the service is not covered.
Part B and supplemental or advantage plans
Many people enroll in a Medigap (supplemental) plan or a Medicare Advantage plan in addition to Part B. Medigap plans help pay the 20 percent copay and deductible that Part B does not cover. Medicare Advantage plans replace Part B and Part A with a single plan from a private insurer; they often include dental, vision, and hearing coverage that Part B does not.
If you have a Medigap plan, you still have Part B, and Part B remains your primary insurance. If you have a Medicare Advantage plan, you do not need a separate Medigap plan, and your coverage works differently — you may have copays instead of coinsurance, and you must use in-network providers.
When to enroll in Part B and what happens if you miss the important date
You are automatically enrolled in Part B when you turn 65 if you are already receiving Social Security benefits. If you are not yet receiving benefits, you must enroll during your initial enrollment period, which begins three months before the month you turn 65 and ends three months after. If you miss this window, you may face a permanent penalty on your Part B premium.
The penalty is 10 percent of the standard premium for each full year you delayed enrollment, and it stays on your premium for as long as you have Part B. You can enroll later during the General Enrollment Period (January 1 to March 31 each year), but the penalty still applies.
Frequently Asked Questions
Does Part B cover my annual physical exam?
Yes. Part B covers one annual wellness visit at no cost to you, with no deductible or copay. This visit includes a health assessment, review of your medications, and screening for depression and cognitive impairment. If your doctor diagnoses a condition during this visit and you need treatment, that treatment is subject to your deductible and 20 percent copay.
Will Part B pay for my blood pressure medication?
No. Prescription drugs you take at home are covered under Part D, not Part B. You must enroll in a Part D plan separately to have coverage for medications. If a drug is given by injection in your doctor's office, it may be covered by Part B — ask your provider.
What if my doctor is not a Medicare provider?
If your doctor does not accept Medicare, you will likely pay the full cost of your visit and receive no reimbursement from Medicare. Before scheduling an appointment, call your doctor's office and confirm they accept Medicare assignment. You can search for Medicare providers on the Medicare.gov provider search tool.
Does Part B cover urgent care or walk-in clinics?
Yes, if the urgent care center or walk-in clinic is enrolled with Medicare. Not all are. Call ahead to confirm the facility accepts Medicare before you go, or ask for a bill estimate so you know what you will owe.
Can I drop Part B if I do not think I need it?
You can drop Part B, but if you enroll again later, you may face a permanent premium penalty. The only exception is if you have employer coverage through your job or your spouse's job — you can delay Part B without penalty as long as you are covered by that employer plan.