Medicare Part B covers doctor visits, outpatient hospital care, medical equipment, and preventive services

Medicare Part B is the part of Original Medicare that pays for services outside a hospital stay. It covers your visits to doctors and specialists, lab tests and imaging, outpatient surgery, mental health care, and equipment like wheelchairs or oxygen. Part B also pays for preventive care — screenings, vaccines, and wellness visits — at no cost to you beyond your monthly premium.

Part B is optional, but most people who have Part A (hospital insurance) also enroll in Part B. If you delay Part B after you first become may be able to access, you may pay a higher premium for life. The standard monthly premium changes each year; in 2024 it ranges based on your income, but you can find your specific amount on your Medicare bill or by calling 1-800-MEDICARE.

Key Takeaways

  • Medicare Part B covers doctor office visits, specialist consultations, lab work, X-rays, and imaging scans at no cost after you meet your annual deductible.
  • Preventive services such as annual wellness visits, cancer screenings, and vaccines are covered at no cost with no deductible.
  • Part B pays for outpatient hospital services, emergency room visits, and same-day surgery, but not inpatient hospital stays (that is Part A).
  • You pay a monthly premium for Part B, an annual deductible, and then 20 percent coinsurance for most services after the deductible is met.
  • Part B does not cover dental, vision, hearing aids, or long-term care, though some Medicare Advantage plans may offer limited coverage for these.

Doctor Visits and Specialist Care

Part B covers visits to your primary care doctor, specialists like cardiologists or rheumatologists, and urgent care clinics. You pay nothing for the visit itself if your doctor accepts Medicare assignment (most do). After you meet your annual deductible — $240 in 2024, though this changes yearly — you pay 20 percent of what Medicare approves for the visit.

If you see a doctor who does not accept Medicare assignment, you may pay more out of pocket. Before your visit, you can ask the office whether the doctor is "in network" with Medicare or call 1-800-MEDICARE to check. Some doctors limit how many Medicare patients they see, so calling ahead to confirm they are accepting new patients is worth doing.

Lab Tests, Imaging, and Diagnostic Services

Part B covers blood tests, urinalysis, EKGs, X-rays, CT scans, ultrasounds, and other diagnostic imaging ordered by your doctor. Like doctor visits, you pay nothing for these services after you meet your deductible, then 20 percent coinsurance. If the test is done in a hospital outpatient department rather than a doctor's office, the cost structure may differ slightly, but Part B still covers it.

Preventive screening tests — such as colonoscopies for colorectal cancer, mammograms for breast cancer, and bone density scans — are covered at no cost, even before you meet your deductible. Part B also covers cardiovascular screening blood tests and diabetes screening if your doctor orders them based on your health history.

Preventive Care and Wellness Services

Medicare Part B covers an annual wellness visit with your doctor at no cost. During this visit, your doctor reviews your health history, takes your blood pressure and weight, and may discuss preventive care. This is different from a sick visit and does not count toward your deductible.

Part B also covers vaccines at no cost, including the flu shot, pneumonia vaccine, shingles vaccine, and COVID-19 vaccine. Screening tests for cancer, heart disease, and diabetes are covered without a deductible. If your doctor finds something during a preventive visit that needs treatment, that follow-up visit or test may have a cost-sharing amount.

Outpatient Hospital Services and Emergency Care

Part B covers services you receive in a hospital outpatient department, such as emergency room visits, same-day surgery, or observation stays. You pay your deductible and then 20 percent coinsurance for these services. An observation stay is when you are in the hospital but not formally admitted as an inpatient — Part B covers this, but Part A does not.

If you go to the emergency room and are admitted to the hospital as an inpatient, Part A (not Part B) covers your hospital stay. However, if you go to the ER and are treated and released the same day, Part B covers that visit. It is important to know your admission status because it affects your costs and what happens next — ask the hospital staff to clarify whether you are being admitted or treated as an outpatient.

Mental Health and Therapy Services

Part B covers mental health services, including visits to psychiatrists, psychologists, clinical social workers, and counselors. You pay your deductible and then 20 percent coinsurance for these visits, the same as for any other doctor visit. Part B also covers psychiatric medications prescribed during these visits.

Substance use disorder treatment, including counseling and medication-assisted treatment, is also covered by Part B. If you need inpatient mental health care in a hospital, Part A covers that stay. Some people find that mental health services are easier to access through a Medicare Advantage plan, which may have lower copays or no referral requirements.

Medical Equipment and Supplies

Part B covers durable medical equipment (DME) such as wheelchairs, walkers, canes, oxygen equipment, CPAP machines, and hospital beds if your doctor prescribes them. You pay 20 percent coinsurance after your deductible. The equipment must be prescribed by a doctor and ordered through a Medicare-approved DME supplier.

Part B also covers diabetic supplies — test strips, lancets, and glucose monitors — and prosthetics like artificial limbs. Rental or purchase of this equipment is covered, but you cannot buy it from any supplier; it must come from a Medicare-approved provider. If you need equipment, ask your doctor for a prescription and request a list of approved suppliers in your area.

What Part B Does Not Cover

Medicare Part B does not cover dental care, eye exams for glasses or contacts, hearing aids, or routine foot care (though it covers foot care if you have diabetes). It does not cover long-term care in a nursing home or assisted living, custodial care, or most cosmetic procedures. Prescription drugs are covered by Part D (prescription drug coverage), not Part B, though some drugs given in a doctor's office or hospital are covered by Part B.

Part B also does not cover services deemed not medically necessary by Medicare, experimental treatments, or care from providers outside the United States (with rare exceptions). If you need services not covered by Part B, you may want to explore whether a Medicare Advantage plan or a Medigap supplemental policy covers them.

Your Costs Under Part B

Your Part B costs have four parts: the monthly premium, the annual deductible, coinsurance, and copays. The monthly premium varies by income and changes each year. The annual deductible is $240 in 2024. After you meet the deductible, you pay 20 percent of the Medicare-approved amount for most services. Some services, like office visits, may have a fixed copay instead of coinsurance.

If you have Original Medicare only and no supplemental coverage, these costs can add up. Many people buy a Medigap policy to cover the deductible and coinsurance, or they choose a Medicare Advantage plan, which has different cost structures — usually lower copays but a network of doctors you must use. Understanding your costs helps you plan for healthcare expenses and decide which coverage option works best for your budget.

Frequently Asked Questions

Do I have to pay anything for preventive services under Part B?

No. Preventive services like annual wellness visits, cancer screenings, vaccines, and cardiovascular screening are covered at no cost with no deductible. If your doctor finds a problem during a preventive visit and you need follow-up care, that follow-up visit may have a cost.

What is the difference between Part B and Part A?

Part A covers inpatient hospital stays, skilled nursing facility care, and hospice. Part B covers doctor visits, outpatient services, tests, and equipment. If you are admitted to the hospital as an inpatient, Part A pays; if you are treated in the ER and sent home, Part B pays.

Can I see any doctor I want with Part B?

Yes, as long as the doctor accepts Medicare assignment. Most doctors do, but some do not. You can call the doctor's office or use the Medicare provider search tool to confirm they accept Medicare before scheduling an appointment.

Does Part B cover prescription medications?

Part B covers some drugs given in a doctor's office or hospital outpatient setting, such as chemotherapy or biologics. Medications you pick up at a pharmacy are covered by Part D (prescription drug coverage), not Part B. You need to enroll in a Part D plan separately.

What happens if I do not enroll in Part B when I first become may be able to access?

If you delay Part B after you first become may be able to access and do not have other may have access to coverage, you may pay a higher premium for as long as you have Medicare. The penalty is 10 percent of the standard premium for each 12 months you were may be able to access but did not enroll.