Medicare Part B covers doctor visits and outpatient care, but it has real gaps
Medicare Part B pays for doctor office visits, lab tests, imaging, and outpatient procedures — but the policy stops short in several places where you might expect coverage. Part B does not cover dental work, vision care, hearing aids, long-term care, or most prescription drugs. It also does not pay for routine physical exams, certain preventive screenings, or treatments your doctor considers experimental. Understanding what falls outside Part B is the only way to know whether you need a supplemental plan, a Medicare Advantage plan, or to budget out-of-pocket.
The gaps are not random. Medicare Part B was designed to cover acute medical care — the diagnosis and treatment of illness and injury. It was not designed to cover ongoing maintenance like teeth cleaning or glasses, and it was not designed to cover the long institutional stays that can cost tens of thousands of dollars. Knowing the difference between what Part B covers and what it does not is the first step to planning your actual healthcare costs.
Key Takeaways
- Medicare Part B does not cover dental care, vision exams, eyeglasses, or hearing aids, even if your doctor prescribes them.
- Part B does not pay for most prescription drugs — that is Part D — and does not cover drugs given in a doctor's office or hospital outpatient setting unless they are billed as part of a procedure.
- Long-term care in a nursing home, assisted living facility, or at home is not covered by Part B, though Medicare Part A covers limited skilled nursing stays after a hospital admission.
- Routine physical exams and some preventive services are not covered, though Part B does cover certain screenings like colonoscopies and mammograms when medically necessary.
- Many people use a Medigap supplemental plan or a Medicare Advantage plan to cover services Part B leaves out.
Dental, Vision, and Hearing — Three Major Gaps
Part B does not cover routine dental care, dental exams, cleanings, fillings, crowns, or dentures. It also does not cover vision exams, eyeglasses, contact lenses, or the frames. Hearing aids and hearing exams are not covered either. These three categories account for a large share of out-of-pocket spending for people on Medicare, and many people are surprised to learn they are not included.
The only exception is if dental, vision, or hearing treatment is part of a covered medical procedure. For example, if you need a tooth extracted before radiation therapy for cancer, that extraction might be covered as part of cancer treatment. But routine care — the cleaning, the exam, the new glasses — is your responsibility. Some people purchase standalone dental, vision, or hearing plans through private insurers, or they use discount plans that negotiate lower rates with providers. Others budget for these costs or go without.
Prescription Drugs and What Part B Actually Covers
Part B does not cover prescription drugs you take at home. That is the job of Part D, the prescription drug plan you choose separately. However, Part B does cover certain drugs that are given to you in a doctor's office or hospital outpatient setting as part of a procedure — for example, chemotherapy drugs given during an office visit, or an injection for a joint.
The line between what Part B covers and what Part D covers can be confusing because it depends on how and where the drug is given, not on the drug itself. If your doctor injects you with a medication in the office, Part B may cover it. If you take the same medication as a pill at home, Part D covers it. If you are unsure whether a specific drug will be covered, ask your doctor's office to check before you receive it, because the bill can be substantial if it is not covered.
Long-Term Care and Custodial Services
Medicare Part B does not cover long-term care — the ongoing support you need if you cannot manage daily activities like bathing, dressing, or taking medication on your own. This includes nursing home care, assisted living, adult day care, and home health aides who come to help with personal care. These services can cost thousands of dollars per month, and they are one of the largest uncovered expenses for older adults.
Medicare Part A does cover a limited stay in a skilled nursing facility — up to 100 days — but only if you have been hospitalized for at least three days and you are admitted to the facility for continued treatment of the same condition. This is not the same as long-term care. Once the skilled nursing stay ends, you pay out of pocket or you turn to Medicaid, which does cover long-term care for people who meet income and asset limits. Long-term care insurance, if purchased before you need it, can help cover these costs, but it is expensive and must be bought while you are still healthy.
Preventive Services and Routine Exams
Part B does not cover routine physical exams — the annual checkup where your doctor listens to your heart and checks your blood pressure. However, Part B does cover certain preventive services when they are ordered for a specific medical reason. For example, Part B covers a colonoscopy if your doctor orders it to screen for colorectal cancer, and it covers a mammogram for breast cancer screening. The distinction is between a general checkup and a test ordered to look for a specific condition.
Part B also does not cover routine eye exams or routine hearing tests. It covers eye exams only if they are part of treatment for a medical condition like glaucoma or cataracts. This means that if you want to know whether your vision or hearing has changed, you pay for that visit yourself. Some Medicare Advantage plans include routine vision and hearing exams as an added benefit, which is one reason people choose them over Original Medicare with a Medigap plan.
Experimental Treatments and Certain Therapies
Part B does not cover treatments that Medicare considers experimental or investigational. This includes new drugs, new surgical techniques, or new devices that have not yet been approved by Medicare as standard treatment. If your doctor wants to try an experimental approach, you may be able to participate in a clinical trial, which sometimes covers the experimental treatment. But outside a trial, you would pay for it yourself.
Part B also limits coverage for certain therapies. Physical therapy, occupational therapy, and speech therapy are covered only if they are medically necessary and ordered by a doctor — not if you want them for general wellness or fitness. Mental health services are covered, but only in certain settings and with certain limitations on the number of visits. If you need ongoing mental health support, check your plan's rules before you start treatment.
Travel, Comfort Items, and Services Outside the United States
Part B does not cover medical care outside the United States, except in very limited circumstances — for example, if you are traveling between Alaska and the continental U.S. and need emergency care in Canada or Mexico. If you travel internationally, you need to purchase travel health insurance or pay out of pocket for any medical care you receive abroad.
Part B also does not cover comfort items or convenience services — things like a private hospital room (unless medically necessary), a television in your hospital room, or a telephone. It does not cover transportation to medical appointments, meals, or lodging. Some of these services may be covered by a Medicare Advantage plan or a Medigap plan, so check your specific coverage if these are important to you.
How to Cover the Gaps: Medigap and Medicare Advantage
Most people on Original Medicare Part B purchase either a Medigap supplemental plan or switch to a Medicare Advantage plan to cover services Part B does not include. A Medigap plan is sold by private insurers and covers some of the costs that Part B leaves out — like coinsurance and copayments — but it does not cover dental, vision, or hearing. A Medicare Advantage plan is an alternative to Original Medicare, offered by private insurers, and it often includes dental, vision, and hearing benefits, though the coverage varies by plan and by year.
Neither Medigap nor Medicare Advantage covers long-term care, so you still need to plan separately for that possibility. Some people purchase long-term care insurance, some rely on Medicaid, and some plan to pay out of pocket or rely on family support. The choice depends on your health, your assets, and your family situation. Understanding what Part B does not cover is the foundation for making that choice.
Frequently Asked Questions
Does Medicare Part B cover my annual physical exam?
No. Part B does not cover routine physical exams. However, Part B does cover certain preventive services like colonoscopies, mammograms, and blood pressure checks when your doctor orders them for a specific medical reason. If you want a general checkup, you pay for it yourself.
Will Part B pay for my hearing aids?
No. Part B does not cover hearing aids or hearing exams. You pay for these out of pocket, or you may find a discount hearing aid program. Some Medicare Advantage plans include hearing aid coverage, so you can compare plans to see what is available in your area.
What if my doctor prescribes a drug I cannot afford?
If it is a drug you take at home, Part D (prescription drug coverage) should cover it, though you may have a copayment or coinsurance. If it is a drug given in your doctor's office, Part B may cover it. If neither covers it, ask your doctor about generic alternatives, patient information programs, or discount programs. Your doctor's office can often help you find lower-cost options.
Does Medicare cover nursing home care?
Part A covers up to 100 days in a skilled nursing facility after a hospital stay of at least three days, but only for continued treatment of the condition that sent you to the hospital. Long-term custodial care in a nursing home is not covered by Medicare. Medicaid covers it for people who meet income and asset limits, or you can purchase long-term care insurance or pay out of pocket.
Can I get coverage for dental work if my doctor says I need it?
Not through Part B. Even if your doctor prescribes dental treatment, Part B does not cover it. The only exception is if the dental work is part of a covered medical procedure — for example, a tooth extraction before cancer treatment. Otherwise, you pay for dental care yourself or through a standalone dental plan.