Medicare Part B covers doctor visits, outpatient care, and some preventive services

Medicare Part B is the medical insurance piece of Original Medicare. It pays for visits to doctors and specialists, hospital outpatient services (like emergency room visits and surgery centers), diagnostic tests, and certain equipment and supplies. Part B does not cover hospital stays — that is Part A — and it does not cover prescription drugs, dental, vision, or hearing aids.

Part B is optional, but most people who have Part A enroll in it. You pay a monthly premium (the amount changes each year based on your income), and then Part B covers 80 percent of approved charges after you meet your yearly deductible. You pay the remaining 20 percent, which is called coinsurance.

Key Takeaways

  • Part B covers doctor office visits, specialist consultations, lab work, imaging, and outpatient procedures at hospitals and surgery centers.
  • Part B pays 80 percent of the Medicare-approved amount after you meet your annual deductible; you pay 20 percent coinsurance.
  • Preventive services like annual wellness visits, cancer screenings, and vaccines are covered with no coinsurance or deductible.
  • Part B does not cover dental, vision, hearing aids, prescription drugs, or routine foot care, and it does not pay for hospital inpatient stays.
  • If you delay enrolling in Part B when you first become may be able to access, you may face a permanent penalty on your premium.

Doctor visits and specialist care

Part B covers visits to your primary care doctor, cardiologists, orthopedists, neurologists, and other specialists. It pays for the office visit itself and for any evaluation or management services the doctor provides during that visit. If your doctor orders lab work or imaging as part of your care — blood tests, X-rays, ultrasounds, CT scans — Part B covers those too.

You will pay a copay at some offices (a fixed amount like $15 or $20), but Medicare's standard cost-sharing is the 20 percent coinsurance after your deductible. The deductible for Part B in 2024 is $240 per year; it changes annually. Once you have paid $240 out of pocket for Part B services in a calendar year, coinsurance kicks in for the rest of that year.

Hospital outpatient services and emergency care

Part B covers emergency room visits, urgent care center visits, and outpatient surgery at hospitals or ambulatory surgery centers. If you go to the ER and are treated and released, Part B pays its share. If you are admitted to the hospital as an inpatient, Part A takes over instead.

Outpatient rehabilitation — physical therapy, occupational therapy, or speech therapy provided at a hospital or clinic rather than in your home — is also covered by Part B. The same 20 percent coinsurance applies after your deductible.

Preventive services with no cost-sharing

Part B covers a range of preventive services at no charge to you — meaning no deductible and no coinsurance. These include an annual wellness visit with your doctor (sometimes called a "Welcome to Medicare" visit if you are new to Medicare), colorectal cancer screening, mammograms, prostate cancer screening, diabetes screening, cardiovascular screening, and bone density testing.

Vaccines are also covered with no cost-sharing: the flu shot, pneumococcal vaccine, shingles vaccine, and others recommended by the CDC. If your doctor orders a preventive service and it turns into a diagnostic or treatment service — for example, a screening colonoscopy finds a polyp that needs to be removed — you may owe coinsurance for the treatment portion.

Durable medical equipment and supplies

Part B covers durable medical equipment (DME) — items that are meant to last and can be used repeatedly, such as wheelchairs, walkers, canes, oxygen equipment, CPAP machines, and hospital beds. You typically pay 20 percent coinsurance after your deductible. The equipment must be prescribed by a doctor and obtained from a Medicare-approved supplier.

Diabetic supplies like test strips, lancets, and glucose monitors are covered. Ostomy supplies and catheter supplies are also included. Prosthetics and orthotics — artificial limbs and braces — are covered when medically necessary.

Mental health and therapy services

Part B covers mental health services including visits to psychiatrists, psychologists, clinical social workers, and nurse specialists in psychiatry. Outpatient therapy and counseling are covered at the same 20 percent coinsurance rate as other Part B services. Substance abuse treatment in an outpatient setting is also covered.

If you need inpatient psychiatric care in a hospital, Part A covers that stay, not Part B. Telehealth mental health visits are covered under the same rules as in-person visits.

What Part B does not cover

Part B does not pay for prescription drugs — that is covered by Part D (prescription drug plans) or by a Medicare Advantage plan. Dental care, including cleanings, fillings, and extractions, is not covered. Vision care such as eye exams for glasses or contacts, glasses, and contact lenses are not covered, though Part B does cover eye exams related to diseases like glaucoma or cataracts.

Hearing aids and hearing exams for the purpose of fitting hearing aids are not covered by Part B. Routine foot care, including toenail trimming and callus removal, is not covered unless you have a medical condition like diabetes that makes foot care medically necessary. Cosmetic surgery is not covered. Long-term care, nursing home care, and custodial care are not covered by any part of Original Medicare.

Frequently Asked Questions

Do I have to pay anything if I go to the doctor and Part B covers the visit?

Yes. You pay your monthly Part B premium regardless. At the visit, you pay either a copay (if your doctor's office uses copays) or 20 percent coinsurance after you have met your yearly deductible. Some preventive services have no copay or coinsurance, but most office visits do.

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

If you delay enrolling without a valid reason, you will pay a permanent penalty on your Part B premium for as long as you have Medicare. The penalty is 10 percent of the standard premium for each full year you were may be able to access but not enrolled. There are some exceptions — for example, if you are still working and have employer coverage, you may not face a penalty.

Does Part B cover telehealth visits?

Yes. Telehealth visits with doctors, specialists, and mental health providers are covered by Part B under the same rules as in-person visits. You pay the same copay or coinsurance. Not all doctors offer telehealth, so you will need to ask your provider whether they do.

If I have a Medicare Advantage plan instead of Original Medicare, does Part B still explore?

Medicare Advantage plans include Part B coverage as part of the plan, so you still have Part B benefits. However, the copays, coinsurance, and deductibles may be different from Original Medicare, and you may have network restrictions on which doctors you can see.

Are there any Part B services that are covered with no deductible?

Yes. Preventive services like annual wellness visits, cancer screenings, vaccines, and certain other preventive care have no deductible and no coinsurance. However, if a preventive service leads to a diagnostic or treatment service, you will owe cost-sharing for the treatment portion.