Medicare Part B covers most doctor visits, but not all of them
Medicare Part B pays for visits to your doctor's office, urgent care centers, and hospital outpatient departments when you see a doctor for a medical problem. You pay a monthly premium for Part B, and then you share the cost of each visit with Medicare — you typically pay 20 percent of what Medicare approves, after you meet your yearly deductible.
The key word is "medical." Part B covers visits for diagnosis, treatment, and management of illness or injury. It does not cover routine physical exams, preventive screenings, or dental work. Understanding which visits are covered and which are not helps you plan your healthcare spending and avoid surprise bills.
Key Takeaways
- Medicare Part B covers doctor visits for illness, injury, and ongoing treatment, but you pay 20 percent of the approved cost after your deductible.
- Annual wellness visits and most preventive screenings are covered at no cost to you, even though they are not "sick visits."
- Routine physical exams, dental care, vision care, and hearing aids are not covered by Part B and require separate coverage or out-of-pocket payment.
- Your doctor's office must accept Medicare assignment for you to pay only your 20 percent share; if they do not, you may owe more.
- Telehealth visits with your doctor are covered the same way as in-person visits, with the same cost-sharing rules.
What Part B covers: doctor visits for medical problems
When you have a symptom, illness, or injury, Part B covers the visit to diagnose and treat it. This includes visits to your primary care doctor, specialists, urgent care centers, and hospital outpatient clinics. You pay 20 percent of the Medicare-approved amount after you meet your Part B deductible, which is $240 per year in 2024 (the amount may change each year).
Part B also covers ongoing visits to manage chronic conditions like diabetes, heart disease, or arthritis. If your doctor prescribes follow-up appointments to monitor your condition or adjust your treatment, those visits are covered. Lab work and imaging ordered during the visit — such as blood tests or X-rays — are also covered under Part B, though you pay your share of those costs as well.
Preventive visits and screenings that Part B covers at no cost
Medicare Part B covers an annual wellness visit at no cost to you, even though you have not come in sick. During this visit, your doctor reviews your health history, takes your vital signs, and may discuss preventive care. This is different from a traditional physical exam and does not include a full head-to-toe examination.
Part B also covers many preventive screenings at no cost: mammograms for breast cancer, colonoscopies for colorectal cancer, bone density scans, cardiovascular screenings, and diabetes screenings. You do not pay your usual 20 percent share for these covered preventive services. However, if your doctor finds a problem during the screening and performs a treatment or biopsy, you may owe cost-sharing for that additional work.
What Part B does not cover
Routine physical exams — the kind you might get for a job or sports clearance — are not covered by Part B. If you want a physical exam when you are not sick, you pay out of pocket. Dental care, including cleanings, fillings, and extractions, is not covered. Vision care and eyeglasses are not covered. Hearing aids and hearing exams are not covered.
Cosmetic procedures are not covered, nor are most weight-loss programs or acupuncture. If your doctor refers you to a mental health counselor or therapist, that visit may be covered under Part B, but only if it is for treatment of a diagnosed mental health condition — not for general life coaching or wellness counseling.
How much you pay: deductibles and cost-sharing
For 2024, the Part B deductible is $240 per year. Once you meet this deductible, you pay 20 percent of the Medicare-approved amount for each doctor visit. If your doctor's office charges more than Medicare approves, and your doctor does not accept Medicare assignment, you may owe the difference on top of your 20 percent share.
To avoid surprise bills, ask your doctor's office whether they accept Medicare assignment before your visit. If they do, they agree to accept Medicare's approved amount as payment in full (after you pay your 20 percent). If they do not, you could owe significantly more. You can also check the Medicare provider directory online to see whether a doctor accepts assignment.
Telehealth visits through Medicare
Doctor visits by video or phone are covered by Part B under the same rules as in-person visits. You pay 20 percent of the approved cost after your deductible, and the visit counts toward your deductible just as an office visit does. Your doctor's office will tell you how to set up a telehealth appointment and what technology you need.
Not all doctors offer telehealth, and some may charge differently for virtual visits than for office visits. Ask your doctor whether they offer telehealth and what the process is. If you have trouble with the technology, many offices can help you set up the call or video before your appointment.
When you see a specialist
Part B covers visits to specialists — cardiologists, orthopedists, neurologists, and others — under the same rules as visits to your primary care doctor. You do not need a referral from your primary care doctor to see a specialist on Medicare Part B, though your doctor may recommend one. You still pay 20 percent of the approved cost after your deductible.
If a specialist orders tests, imaging, or procedures during your visit, those are covered by Part B as well, and you pay your share of those costs. Make sure the specialist's office knows you have Medicare and accepts it before your appointment to avoid billing surprises.
Frequently Asked Questions
Do I have to pay anything for an annual wellness visit?
No. The annual wellness visit is covered at no cost to you — you do not pay your deductible or a 20 percent share. However, if your doctor finds a problem during the visit and performs additional testing or treatment, you may owe cost-sharing for that extra work.
What if my doctor charges more than Medicare approves?
If your doctor accepts Medicare assignment, they agree to accept Medicare's approved amount as full payment. You pay only your 20 percent share. If your doctor does not accept assignment, you may owe the difference between what they charge and what Medicare approves, on top of your 20 percent share. Always confirm your doctor accepts assignment before your visit.
Are mental health visits covered by Part B?
Yes, visits to a psychiatrist, psychologist, or licensed counselor are covered by Part B when you are being treated for a diagnosed mental health condition like depression or anxiety. You pay 20 percent of the approved cost after your deductible, the same as for other doctor visits.
Does Part B cover urgent care or emergency room visits?
Part B covers urgent care center visits for non-emergency problems. Emergency room visits are covered by Medicare Part A (hospital insurance) if you are admitted to the hospital, or by Part B if you are treated and released. You pay differently depending on whether you are admitted, so ask the hospital billing department how your visit will be billed.
Can I use Part B to see any doctor I want?
Yes. Part B has no network restrictions — you can see any doctor who accepts Medicare. However, if your doctor does not accept Medicare assignment, you may pay more out of pocket. Check whether your doctor accepts Medicare assignment before scheduling your visit.