Medicare Part B covers doctor visits, lab tests, imaging, and outpatient hospital care
Medicare Part B is the medical insurance portion of Original Medicare. It pays for services from doctors and other providers when you go to their office, a clinic, or an outpatient hospital department. Part B does not cover hospital stays (that is Part A), prescriptions (that is Part D), or long-term care. You pay a monthly premium for Part B, and then you pay a share of the cost when you use services.
Part B covers the full range of outpatient care: office visits with your primary doctor or a specialist, physical therapy, mental health counseling, lab work, X-rays, ultrasounds, CT scans, and procedures done in a doctor's office or outpatient surgery center. It also covers some equipment and supplies you use at home, like oxygen, wheelchairs, and diabetic testing strips. The key is that the service must be ordered by a doctor and considered medically necessary.
Key Takeaways
- Part B covers doctor office visits, specialist visits, lab tests, imaging (X-rays, ultrasounds, CT scans), and outpatient procedures at no cost after you meet your deductible.
- You pay a monthly premium for Part B (the amount changes each year based on your income), plus a deductible each year, plus 20 percent coinsurance on most services.
- Part B does not cover routine dental, vision, or hearing care, and does not cover prescriptions filled at a pharmacy.
- Services must be ordered by a doctor and deemed medically necessary; preventive services like annual wellness visits and cancer screenings are covered at no cost to you.
What Part B pays for: the main categories
Doctor and specialist visits are covered when you see your primary care doctor, a cardiologist, orthopedist, neurologist, or any other licensed physician. This includes office visits, phone visits, and video visits with your doctor. Part B also covers visits to nurse practitioners, physician assistants, and clinical social workers when they are working independently or under a doctor's supervision.
Diagnostic tests and imaging are covered when your doctor orders them. This includes blood tests, urinalysis, EKGs, stress tests, X-rays, ultrasounds, CT scans, MRIs, and PET scans. Part B also covers pathology services — the lab analysis of tissue samples or blood work. If the test is done in a hospital outpatient department, Part B covers it; if you are admitted to the hospital as an inpatient, Part A covers it instead.
Outpatient procedures are covered when done in a doctor's office, clinic, or hospital outpatient department. This includes biopsies, cataract surgery, joint injections, minor surgery, and endoscopy. Part B does not cover procedures done on an inpatient basis (you would be admitted to the hospital overnight), which fall under Part A.
Mental health and therapy services are covered, including visits with a psychiatrist, psychologist, clinical social worker, or counselor. Part B also covers physical therapy, occupational therapy, and speech-language pathology when ordered by a doctor for a medical condition. Therapy visits are usually limited to a certain number per year unless your doctor documents medical necessity for more.
Preventive services covered at no cost
Part B covers many preventive services with no deductible and no coinsurance — you pay nothing out of pocket. These include your annual wellness visit (a comprehensive physical and health assessment), cancer screenings (mammogram, colonoscopy, Pap test, prostate screening), cardiovascular screening, diabetes screening, bone density screening, and vaccinations (flu, pneumonia, shingles, COVID-19).
Preventive services are covered only when they are done for screening purposes — to catch disease early in someone with no symptoms. If you have symptoms or a known condition and your doctor orders a test to diagnose or monitor it, that test is not preventive and you will pay your deductible and coinsurance. For example, a screening colonoscopy for someone with no symptoms is free; a colonoscopy to investigate bleeding is not.
Equipment, supplies, and home services covered by Part B
Part B covers durable medical equipment (DME) — items you use at home that last more than a few months. This includes wheelchairs, walkers, canes, hospital beds, oxygen equipment, CPAP machines, and diabetic testing supplies. You pay 20 percent coinsurance after your deductible. The equipment must be prescribed by a doctor and obtained from a Medicare-approved supplier.
Part B also covers home health services when you are homebound and a doctor orders them. This includes nursing care, physical therapy, occupational therapy, and speech therapy delivered to your home. You pay nothing for home health services if they are ordered by a doctor and provided by a Medicare-certified agency. Home health is different from home care or housekeeping services, which are not covered.
What Part B does not cover
Part B does not cover routine dental, vision, or hearing care. This means cleanings, fillings, dentures, eyeglasses, contact lenses, hearing aids, and routine eye exams are not covered. Some dental or vision care related to a medical condition (such as jaw surgery or cataract removal) may be covered, but routine care is not.
Part B does not cover prescription medications filled at a pharmacy. Medications given to you in a doctor's office or hospital outpatient department (such as an injection or infusion) are covered by Part B. Medications you take home to use yourself are covered by Part D, the prescription drug plan.
Part B also does not cover cosmetic procedures, weight loss programs, most foot care (unless you have diabetes), routine physicals for work or travel, or services from providers outside the United States.
How much you pay: premiums, deductibles, and coinsurance
You pay a monthly premium for Part B. The standard premium amount changes each year; in 2024 it ranges based on your income, with higher-income beneficiaries paying more. You can find the current premium amount on the Medicare website or by calling 1-800-MEDICARE.
You also pay an annual deductible each year before Part B starts paying. Once you meet the deductible, Part B pays 80 percent of the cost of covered services, and you pay 20 percent coinsurance. For example, if you have a doctor visit that costs $100 and you have already met your deductible, Medicare pays $80 and you pay $20.
If you have a Medigap policy (supplemental insurance), it may pay your deductible and coinsurance. If you have a Medicare Advantage plan (Part C), you have different cost-sharing rules set by that plan. Your actual out-of-pocket costs depend on which type of coverage you have.
When to contact your doctor or Medicare
Contact your doctor if you are unsure whether a service is medically necessary or if you want to know whether Part B will cover it before you have the service. Your doctor's office can also check with Medicare on your behalf. This is especially important for expensive tests or procedures.
Contact Medicare directly at 1-800-MEDICARE if you have questions about what Part B covers, what your costs will be, or whether a specific provider or supplier is Medicare-approved. You can also visit Medicare.gov and use the "Find Care Providers" tool to check whether a doctor or facility accepts Medicare.
Frequently Asked Questions
Does Part B cover my annual physical exam?
Yes. Part B covers one annual wellness visit per year at no cost to you. This is a comprehensive physical that includes a health assessment, review of your medications, and screening for depression and cognitive impairment. This is different from a sick visit to your doctor, which is also covered but subject to your deductible and coinsurance.
Will Part B cover my colonoscopy?
Yes, if it is a screening colonoscopy (done because you have no symptoms and are due for screening). You pay nothing. If the colonoscopy is done because you have symptoms like bleeding or abdominal pain, it is diagnostic rather than preventive, and you will pay your deductible and 20 percent coinsurance.
Does Part B cover my blood pressure medication?
No. Part B does not cover medications you pick up at a pharmacy. Those are covered by Part D, the prescription drug plan. If your doctor gives you a medication by injection or infusion in the office or outpatient hospital, Part B covers that.
What happens if I see a doctor who does not accept Medicare?
If your doctor does not accept Medicare, you will likely have to pay the full cost of the visit yourself. Part B will not pay anything. Before scheduling an appointment, ask the doctor's office whether they accept Medicare assignment (meaning they accept Medicare's payment as full payment).
Do I have to pay anything for preventive services?
No. Preventive services like cancer screenings, vaccinations, and your annual wellness visit are covered at no cost when done for screening purposes. You pay nothing — no deductible, no coinsurance. If the same test is done for a different reason (to diagnose a symptom), you will pay your deductible and coinsurance.