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

Part B is the part of Medicare that pays for services from doctors and hospitals when you are not admitted as an overnight patient. It covers your visits to your doctor's office, lab tests, imaging like X-rays and ultrasounds, physical therapy, mental health counseling, and ambulance transport. Part B also pays for preventive care — the screenings and vaccines meant to catch disease early, before you need treatment.

Part B does not cover everything a doctor might order. It does not pay for routine dental work, eyeglasses, hearing aids, or most long-term care. It also does not cover prescription drugs — that is Part D. Understanding what Part B does and does not cover helps you plan for out-of-pocket costs and know when to ask your doctor whether Medicare will pay.

Key Takeaways

  • Part B covers doctor office visits, lab work, imaging, and preventive screenings, but you pay a monthly premium and a share of the cost for each service.
  • Preventive services like annual wellness visits, cancer screenings, and vaccines are covered at no cost to you when you see an in-network provider.
  • Part B does not cover dental, vision, hearing aids, or prescription drugs — those require separate coverage or out-of-pocket payment.
  • You are responsible for the deductible each year, then a percentage of the cost (coinsurance) for most services after that.

What Part B pays for: the main categories

Part B covers doctor office visits for any reason — a checkup, a new symptom, or management of a chronic condition like diabetes or heart disease. This includes visits to specialists like cardiologists, orthopedists, and neurologists. It also covers visits to nurse practitioners and physician assistants when they work in an office setting.

Diagnostic and lab services are covered when ordered by your doctor: blood tests, urinalysis, EKGs, X-rays, CT scans, MRIs, and ultrasounds. Part B pays for these whether they happen in a doctor's office, an outpatient imaging center, or a hospital outpatient department.

Outpatient hospital services are covered when you receive care at a hospital but do not stay overnight. This includes emergency room visits, observation stays (which are not the same as admission), same-day surgery, and chemotherapy or dialysis given in the hospital outpatient setting.

Mental health services — therapy and psychiatric visits — are covered at the same rate as other doctor visits. Physical therapy, occupational therapy, and speech therapy are covered when medically necessary and ordered by a doctor, whether in a clinic, hospital, or your home.

Preventive services covered at no cost

Medicare Part B covers certain preventive services with no deductible and no coinsurance when you see a provider who accepts Medicare. These services are meant to catch disease early. They include your annual wellness visit — a comprehensive checkup with your doctor that includes a health history and screening for common conditions.

Cancer screenings covered at no cost include mammograms for breast cancer (yearly for women 40 and older), colonoscopy for colorectal cancer (every 10 years, or more often if needed), and Pap tests for cervical cancer (every three years, or every five years with HPV testing). Bone density screening (DEXA scan) is covered for women 65 and older and for men 70 and older, and for younger people at risk of osteoporosis.

Cardiovascular screenings include blood pressure checks, cholesterol tests, and screening for abdominal aortic aneurysm if you are a man 65 to 75 who has ever smoked. Diabetes screening is covered for people with high blood pressure or other risk factors. Vaccines covered at no cost include the flu shot (yearly), pneumonia vaccine, shingles vaccine, and RSV vaccine for adults 60 and older.

Cognitive screening for memory loss is covered as part of your wellness visit. Depression screening is also covered. These preventive services are free only when you have not met your deductible yet — once you have, the same rules about coinsurance explore as for other services.

What you pay: premiums, deductibles, and coinsurance

You pay a monthly premium for Part B. The standard premium in 2024 is $164.90, though it varies based on your income — higher earners pay more. You pay this premium whether you use Part B services or not.

You also pay an annual deductible before Part B starts to pay. In 2024, the Part B deductible is $240. This means you pay the full cost of services until you have spent $240 out of pocket; after that, Medicare begins to share the cost.

Once you have met your deductible, you pay coinsurance — usually 20 percent of the cost of the service. Medicare pays the other 80 percent. For example, if a lab test costs $100, you pay $20 and Medicare pays $80. Some services, like office visits, may have a fixed copay instead of coinsurance, depending on your plan.

These costs explore only when you see a provider who accepts Medicare assignment — meaning they agree to accept Medicare's payment as full payment for the service. If you see a provider who does not accept assignment, you may owe more.

Services Part B does not cover

Dental care is not covered by Part B, including cleanings, fillings, root canals, and dentures. Vision care is not covered — this includes routine eye exams, eyeglasses, and contact lenses. Hearing aids and hearing exams for the purpose of fitting hearing aids are not covered, though some hearing tests ordered by your doctor for other medical reasons may be.

Prescription drugs are covered by Part D, not Part B. Long-term care — nursing home care, assisted living, or in-home care — is not covered by Medicare at all. Cosmetic surgery is not covered unless it is needed to repair an injury or birth defect.

Routine foot care, including nail trimming and callus removal, is not covered unless you have diabetes or a condition affecting circulation. Weight loss programs and bariatric surgery are not covered. Experimental treatments not yet approved by the FDA are not covered, though some clinical trials may be.

How to know what your specific service will cost

Before you have a service, you can call your doctor's office and ask whether the service is covered by Medicare Part B and what your out-of-pocket cost will be. The office staff can tell you whether the provider accepts Medicare assignment and can estimate your coinsurance based on what Medicare typically pays for that service.

You can also call Medicare directly at 1-800-MEDICARE (1-800-633-4227) to ask whether a specific service is covered. Have the name of the service or procedure ready. Medicare can tell you whether it is covered and what the typical cost-sharing is, though your actual cost may vary based on your deductible status and the provider you see.

If you have a Medigap or Medicare Advantage plan in addition to Part B, your out-of-pocket costs may be lower because those plans help pay your deductible and coinsurance. Check your plan documents or call your plan to find out what you will owe for a specific service.

When to ask your doctor about Part B coverage

Ask your doctor before a service or test if you are unsure whether Medicare will pay. This is especially important if your doctor is ordering something that sounds new or unusual to you, or if you are seeing a provider you have not seen before. Your doctor's office can check coverage quickly.

If your doctor recommends a service that Part B does not cover — such as a dental procedure or a hearing aid — ask whether there is an alternative that Medicare does cover, or whether the service is truly necessary. Sometimes there are covered options you have not considered.

If you receive a bill from a provider after a service, and you believe Medicare should have paid, contact the provider's billing office first. If the issue is not resolved, you can file an appeal with Medicare. Keep all bills and explanation of benefits statements so you have a record of what you paid.

Frequently Asked Questions

Does Part B cover my annual physical exam?

Yes. Medicare Part B covers an annual wellness visit at no cost when you see a provider who accepts Medicare. This visit includes a health history, physical exam, and screening for common conditions. It is different from a sick visit — you schedule it when you are well, not when you have a symptom.

If I have a Medicare Advantage plan instead of Original Medicare, does Part B still cover the same things?

Medicare Advantage plans must cover everything Part B covers, but they may have different cost-sharing — you might pay a copay instead of coinsurance, or have a different deductible. Check your plan documents or call your plan to see what you will owe for a specific service.

Does Part B cover telehealth visits with my doctor?

Yes. Part B covers telehealth visits — video or phone calls with your doctor — at the same rate as in-person visits. You pay the same coinsurance or copay. Not all providers offer telehealth, so ask your doctor's office whether they do.

What happens if I see a doctor who does not accept Medicare?

If a doctor does not accept Medicare assignment, you may owe the full cost of the visit out of pocket, and Medicare will not pay anything. Before you schedule with a new provider, ask whether they accept Medicare. You can also search for Medicare-accepting providers on Medicare.gov.

Does Part B cover home health care?

Part B covers skilled home health services — nursing care, physical therapy, or other therapy ordered by your doctor — when you are homebound and the care is medically necessary. It does not cover custodial care, such as help with bathing or dressing, unless it is part of a skilled service.