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 you receive outside a hospital — mainly visits to doctors and specialists, lab tests, imaging like X-rays and ultrasounds, and equipment your doctor prescribes. It also covers preventive care like screenings and vaccines. Part B does not cover hospital stays (that is Part A), prescription drugs taken at home (that is Part D), or long-term care in a nursing home.

Part B is optional, but most people who have Part A should enroll in Part B. You pay a monthly premium for Part B, and you also pay a share of the cost when you use services — usually a copay or coinsurance. The amount you pay depends on your income and when you first enrolled.

Key Takeaways

  • Part B covers doctor office visits, specialist consultations, lab work, imaging, and outpatient procedures at hospitals or surgery centers.
  • Preventive services covered at no cost to you include annual wellness visits, cancer screenings, heart disease tests, and certain vaccines.
  • You pay a monthly premium for Part B, plus a copay or coinsurance each time you use a covered service.
  • Part B does not cover prescription drugs, dental care, vision exams, hearing aids, or long-term nursing home stays.

Doctor Visits and Specialist Care

Part B pays for visits to your primary care doctor and to specialists like cardiologists, orthopedists, and neurologists. This includes office visits, consultations, and follow-up appointments. Your doctor must accept Medicare for Part B to cover the visit; most do, but you should confirm before your appointment.

When you see a doctor, you typically pay a copay — usually $15 to $50 per visit, depending on your plan and the type of visit. Some doctors charge more than Medicare allows, and you may owe the difference if they do not accept Medicare assignment. Always ask the office staff whether the doctor accepts Medicare and what your out-of-pocket cost will be.

Lab Tests, Imaging, and Diagnostic Services

Part B covers blood tests, urinalysis, and other lab work your doctor orders. It also covers imaging services like X-rays, CT scans, ultrasounds, and MRI scans when medically necessary. These services are usually done at a hospital outpatient department, an imaging center, or a lab.

You pay coinsurance — typically 20% of the Medicare-approved amount — after you have met your annual Part B deductible. The deductible amount changes each year; in 2024 it is $240, but you should check the current year's amount with Medicare or your doctor's office. Once you have paid the deductible, you owe 20% of the cost for most diagnostic services.

Outpatient Hospital and Surgery Center Procedures

Part B covers procedures done at a hospital outpatient department or an ambulatory surgery center — places where you do not stay overnight. This includes minor surgeries, biopsies, cataract removal, joint injections, and other outpatient procedures your doctor recommends.

The cost structure is the same as for other Part B services: you pay your deductible once per year, then 20% coinsurance for the procedure. Hospital outpatient departments sometimes charge facility fees on top of the provider fee, so your total cost may be higher than the same procedure at a surgery center. Ask your doctor or the facility what the total cost will be before your procedure.

Preventive Services at No Cost

Medicare Part B covers many preventive services with no copay or coinsurance — you pay nothing as long as the service is considered preventive and your doctor says it is medically necessary. These include an annual wellness visit with your doctor, blood pressure checks, cholesterol screening, diabetes screening, colorectal cancer screening (colonoscopy or other methods), breast cancer screening (mammogram), cervical cancer screening (Pap test), prostate cancer screening, and abdominal aortic aneurysm screening.

Part B also covers certain vaccines at no cost, including the flu shot, pneumonia vaccine, shingles vaccine, and COVID-19 vaccine. If your doctor orders a test or procedure for a reason other than prevention — for example, to diagnose a symptom you already have — you may owe a copay or coinsurance even if the same test is free when used for screening.

Mental Health and Therapy Services

Part B covers mental health visits with a psychiatrist, psychologist, or clinical social worker. This includes therapy for depression, anxiety, and other mental health conditions. You pay the same copay or coinsurance as you would for a regular doctor visit — usually a copay of $15 to $50, or 20% coinsurance after your deductible.

Part B also covers occupational therapy, physical therapy, and speech-language pathology when your doctor orders them for a medical condition. These services are often done at a rehabilitation facility, outpatient clinic, or your home. You pay 20% coinsurance after your deductible for therapy services.

Durable Medical Equipment and Supplies

Part B covers durable medical equipment — items that last a long time and are medically necessary, such as wheelchairs, walkers, canes, oxygen equipment, CPAP machines, hospital beds, and diabetic supplies. Your doctor must order the equipment, and it must be prescribed for use in your home.

You pay 20% coinsurance after your deductible for most equipment. Some items, like diabetic test strips and lancets, may have different cost-sharing. The equipment must come from a Medicare-approved supplier; if you buy from a non-approved supplier, Medicare will not pay. Ask your doctor to recommend an approved supplier, or search for one on Medicare.gov.

What Part B Does Not Cover

Part B does not cover prescription drugs you take at home — those are covered by Part D. It does not cover dental care, routine eye exams, eyeglasses, or hearing aids. Part B does not pay for long-term care in a nursing home, assisted living, or custodial care. It does not cover routine foot care, cosmetic surgery, or acupuncture (with rare exceptions).

Part B also does not cover services from providers who do not accept Medicare, unless you have agreed in writing beforehand that you will pay out of pocket. Travel outside the United States is not covered, except in limited cases near the U.S. border or on a ship within U.S. territorial waters.

Frequently Asked Questions

Do I have to pay anything for preventive services?

No. Preventive services like annual wellness visits, cancer screenings, and vaccines are covered at no cost when ordered by your doctor for prevention. If your doctor orders the same test to diagnose a symptom you already have, you may owe a copay or coinsurance.

What happens if my doctor does not accept Medicare?

If your doctor does not accept Medicare, you can still see them, but you will likely owe the full cost out of pocket. Before your visit, ask the office whether they accept Medicare and whether they accept Medicare assignment — this tells you whether they have agreed to accept Medicare's payment as full payment.

How much will I pay for a specialist visit?

You typically pay a copay of $15 to $50 per visit, depending on your plan and whether the specialist accepts Medicare assignment. Some specialists charge more than Medicare allows, and you may owe the difference. Call the office before your appointment to confirm your cost.

Does Part B cover physical therapy?

Yes. Part B covers physical therapy, occupational therapy, and speech therapy when your doctor orders them for a medical condition. You pay 20% coinsurance after your annual deductible. Your doctor must refer you, and the therapy must be medically necessary.

What should I do if I think Medicare denied a service I need?

Ask your doctor's office or the provider to explain why Medicare denied it — sometimes it is because the service was not ordered by a doctor, or because it is not considered medically necessary. You have the right to appeal a denial. Contact Medicare at 1-800-MEDICARE or visit Medicare.gov to learn how to file an appeal.