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, X-rays, and equipment like wheelchairs or oxygen. It covers preventive care like annual wellness visits and cancer screenings. Part B does not cover hospital stays (that is Part A), prescription drugs (that is Part D), or long-term care.

Part B is optional, but most people who have Part A should take it. You pay a monthly premium for Part B, and you also pay a share of the cost when you use a service — usually 20 percent of what Medicare approves, after you meet your yearly deductible. The premium and deductible change each year.

Key Takeaways

  • Part B covers doctor and specialist visits, lab tests, imaging, and outpatient procedures at hospitals or surgery centers.
  • Preventive services like annual wellness visits, cancer screenings, and vaccines are covered at no cost to you when you see a doctor who accepts Medicare.
  • You pay a monthly premium for Part B, plus 20 percent of the cost of most services after you meet your deductible.
  • Part B does not cover prescription drugs, dental care, vision care, hearing aids, or hospital stays — those are covered under other parts of Medicare or not at all.

Doctor and Specialist Visits Covered by Part B

Part B pays for visits to your primary care doctor, cardiologists, orthopedists, neurologists, and other specialists. It covers the office visit itself and any tests or procedures the doctor does in the office, such as blood draws, EKGs, or joint injections. If your doctor refers you to a specialist, Part B covers that visit as long as the specialist accepts Medicare.

You will pay 20 percent of the Medicare-approved amount for each visit after you meet your yearly deductible. If a doctor does not accept Medicare assignment — meaning they do not agree to the Medicare fee schedule — you may pay more. Before your visit, you can ask the doctor's office whether they accept Medicare and whether they accept assignment.

Lab Tests, Imaging, and Diagnostic Services

Part B covers blood tests, urinalysis, and other lab work ordered by your doctor. It also covers X-rays, CT scans, MRIs, ultrasounds, and EKGs. These services are covered whether they happen in a doctor's office, an outpatient imaging center, or a hospital outpatient department.

Diagnostic tests related to a specific symptom or condition are covered. Screening tests — tests done when you have no symptoms — are covered only if Medicare has determined they are medically necessary for your age or risk factors. For example, mammograms for breast cancer screening are covered annually for women 40 and older, and colonoscopies for colorectal cancer screening are covered every 10 years starting at age 50.

Outpatient Hospital and Surgery Center Procedures

Part B covers procedures done at a hospital outpatient department or an ambulatory surgery center — places where you are treated and sent home the same day, without an overnight stay. This includes cataract surgery, joint injections, minor surgical procedures, and certain cancer treatments. Part B also covers emergency room visits and urgent care visits.

When you have a procedure at an outpatient facility, you will receive a bill from the facility itself and possibly a separate bill from the doctor or surgeon. Both bills are subject to your Part B deductible and coinsurance. Ask the facility in advance whether they accept Medicare and what your out-of-pocket cost will be.

Preventive Services at No Cost

Part B covers a range of preventive services with no cost to you — you pay nothing, even before you meet your deductible — as long as you see a doctor who accepts Medicare assignment. These include an annual wellness visit with your primary care doctor, blood pressure screening, cholesterol screening, diabetes screening, and depression screening.

Cancer screenings covered at no cost include mammograms (annually for women 40 and older), colonoscopies (every 10 years starting at age 50), and cervical cancer screening. Part B also covers vaccines, including the flu shot, pneumonia vaccine, shingles vaccine, and RSV vaccine (for adults 60 and older). Bone density screening is covered once every two years for women 65 and older and for men 70 and older.

Medical Equipment and Supplies

Part B covers durable medical equipment — items your doctor prescribes that you can use repeatedly, such as wheelchairs, walkers, canes, oxygen equipment, CPAP machines, and hospital beds. It also covers diabetic supplies like test strips and lancets, and ostomy supplies. The equipment must be prescribed by a doctor and ordered from a Medicare-approved supplier.

You will pay 20 percent of the Medicare-approved cost after you meet your deductible. Some suppliers may charge more than Medicare approves, so ask in advance what your cost will be. If you rent equipment rather than buy it, you pay monthly rental fees; after you have paid the equivalent of the purchase price in rentals, the equipment is yours.

What Part B Does Not Cover

Part B does not cover prescription drugs — those are covered under Part D. It does not cover routine dental care, eye exams for glasses or contacts, hearing aids, or routine foot care. Part B does not cover hospital stays (Part A covers those), skilled nursing facility care, home health care, hospice, or long-term care in a nursing home.

Part B also does not cover cosmetic surgery, weight loss surgery (unless medically necessary for a specific condition), acupuncture, or most chiropractic care. If you need services not covered by Medicare, you will pay the full cost yourself, unless you have a supplemental insurance plan (Medigap) or a Medicare Advantage plan that covers additional services.

Your Costs Under Part B

You pay a monthly premium for Part B. The standard premium for 2024 is $164.90 per month, but it may be higher if your income is above a certain threshold. You also pay an annual deductible — $240 for 2024 — before Part B starts paying for most services. After you meet the deductible, you pay 20 percent of the Medicare-approved cost for most services.

Some preventive services have no cost. If you see a doctor who does not accept Medicare assignment, you may pay more than 20 percent. If you reach a very high out-of-pocket cost in a year, Part B has no annual limit on what you pay, unlike some private insurance plans. Many people buy a Medigap policy to help cover the deductible and coinsurance.

Frequently Asked Questions

Do I have to take Part B when I turn 65?

Part B is optional, but if you do not take it when you first become may be able to access, you may pay a penalty for the rest of your life. If you are still working and covered by your employer's health plan, you may be able to delay Part B without penalty. Talk to your employer's benefits office or call Medicare at 1-800-MEDICARE to ask about your situation.

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

You can still see the doctor, but you will likely pay more. If the doctor does not accept Medicare assignment, they can charge up to 15 percent more than the Medicare-approved amount. You will have to pay the full bill upfront and then submit a claim to Medicare yourself. It is best to confirm in advance whether a doctor accepts Medicare.

Are preventive services really free?

Yes, if you see a doctor who accepts Medicare assignment. You pay nothing for the visit or the screening itself. However, if the doctor finds a problem during the preventive visit and does additional testing or treatment for that problem, you will pay your usual 20 percent coinsurance for those additional services.

Does Part B cover physical therapy?

Yes. Part B covers physical therapy, occupational therapy, and speech-language pathology when ordered by a doctor for a medical condition. You pay 20 percent of the cost after your deductible. There is an annual limit on how much Medicare will pay for these services combined, though the limit changes year to year.

What if I cannot afford the Part B premium?

If your income is low, you may may have access to for help paying your Part B premium through a program called Medicaid or the Medicare Savings Program. Contact your state Medicaid office or call 1-800-MEDICARE to learn whether you may have access to and how the process works.