Medicare Part B covers doctor visits, outpatient care, and medical equipment — but not everything

Medicare Part B is the insurance that pays for services from doctors and other providers outside a hospital. It covers office visits, lab tests, X-rays, ambulance rides, some mental health care, and durable medical equipment like wheelchairs and oxygen. Part B does not cover dental work, vision care, hearing aids, or long-term care in a nursing home. 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.

Part B is optional, but most people who have Medicare Part A (hospital insurance) also take Part B. If you do not sign up when you first become may be able to access at 65, you may pay a penalty for as long as you have Medicare. The penalty is a permanent increase to your monthly premium.

Key Takeaways

  • Part B covers doctor visits, lab work, imaging, outpatient surgery, and some mental health services, but you pay a monthly premium and typically 20 percent of the cost.
  • Part B does not cover routine dental, vision, or hearing care, and does not pay for long-term nursing home stays or custodial care.
  • You must sign up for Part B during your initial enrollment period or within three months of turning 65, or you will face a permanent premium increase.
  • Durable medical equipment like oxygen, wheelchairs, and walkers is covered under Part B if a doctor orders it and it meets Medicare's medical necessity rules.
  • Once you meet your annual deductible, you pay 20 percent of approved costs for most Part B services, with no upper limit on your out-of-pocket spending unless you have supplemental or Part D coverage.

What Part B Covers: Doctor Visits and Outpatient Services

Part B pays for visits to your primary care doctor, specialists, and other providers in their office, a clinic, or an outpatient surgery center. This includes the doctor's time, the nurse's time, and basic supplies used during the visit. If your doctor orders lab work — blood tests, urinalysis, or other tests — Part B covers the lab fee. If your doctor orders imaging like an X-ray, ultrasound, or CT scan, Part B covers that too, as long as it is done on an outpatient basis.

Part B also covers certain preventive services at no cost to you, meaning you do not pay your 20 percent share. These include a yearly wellness visit with your doctor, screenings for cancer and heart disease, vaccinations, and bone density tests. The list changes, so ask your doctor which preventive services you may be due for.

Outpatient surgery — procedures done in a surgery center or hospital outpatient department where you go home the same day — is covered under Part B. This includes things like cataract removal, joint injections, and minor skin procedures. If the same procedure is done in a hospital inpatient setting (you stay overnight), it is covered under Part A instead.

Mental Health, Rehabilitation, and Therapy Services

Part B covers mental health visits with a psychiatrist, psychologist, or licensed clinical social worker. You pay the same 20 percent coinsurance as you would for a regular doctor visit. There is no limit on the number of mental health visits you can have in a year, though your doctor must order them and they must be medically necessary.

Physical therapy, occupational therapy, and speech therapy are covered under Part B when ordered by a doctor and provided in an outpatient setting — a clinic, your home, or a hospital outpatient department. If you receive these services in a skilled nursing facility or as part of an inpatient hospital stay, they are covered under Part A instead. Home health services, including nursing care and therapy at home, are also covered under Part B when a doctor orders them and you are homebound.

Durable Medical Equipment and Supplies

Part B covers durable medical equipment — items that can withstand repeated use and are medically necessary. This includes wheelchairs, walkers, canes, crutches, oxygen equipment, CPAP machines, hospital beds, and diabetic supplies like test strips and lancets. Your doctor must order the equipment, and it must meet Medicare's definition of medical necessity. You typically pay 20 percent of the approved cost after you meet your deductible.

You do not own the equipment outright in most cases. Medicare pays a rental company to provide and maintain it. If you rent for long enough, ownership may transfer to you, but the rules vary by item. Ask the supplier whether you will own the equipment or rent it, and for how long.

Diabetic supplies are treated differently. If you have diabetes, Part B covers blood sugar test strips, lancets, and glucose monitors. You can order these through a Medicare-approved supplier, and you pay 20 percent of the approved cost. Insulin itself is covered under Part D (prescription drug coverage), not Part B.

What Part B Does Not Cover

Part B does not cover routine dental care, including cleanings, fillings, and extractions. It also does not cover dentures or dental implants. The only exception is dental work that is part of a covered procedure — for example, if you need a tooth extracted before jaw surgery, the extraction might be covered as part of the surgical package.

Vision care is not covered under Part B. This includes routine eye exams, eyeglasses, and contact lenses. The only exception is one pair of eyeglasses or one contact lens fitting after cataract surgery if the surgery was covered by Medicare. Hearing aids and hearing exams are not covered. Routine foot care, including nail trimming, is not covered unless you have diabetes and the care is related to your diabetes.

Long-term care in a nursing home — called custodial care — is not covered under Part B or any part of Medicare. Part A covers a limited stay in a skilled nursing facility (up to 100 days) only if you were hospitalized first and meet other conditions. If you need ongoing help with daily activities like bathing, dressing, or eating, you pay out of pocket or through Medicaid if you may have access to.

Cosmetic surgery is not covered. Weight loss surgery is not covered unless it is medically necessary to treat a specific condition. Experimental treatments are not covered unless you are in a Medicare-approved clinical trial.

How Much You Pay: Premiums, Deductibles, and Coinsurance

You pay a monthly premium for Part B. The standard premium in 2024 is $164.90 per month, but the amount changes each year and may be higher if your income is above a certain level. If you receive Social Security, the premium is usually taken directly from your check.

You also pay an annual deductible before Part B starts paying. In 2024, the Part B deductible is $240. Once you meet the deductible, you pay 20 percent of the approved cost for most services. There is no annual limit on how much you pay out of pocket under Part B alone. If you have a Medigap supplemental policy or a Medicare Advantage plan, your out-of-pocket costs may be lower.

If you do not sign up for Part B when you first become may be able to access, you pay a permanent penalty. The penalty is 10 percent of the standard premium for each full year you were may be able to access but did not sign up. If you waited three years, your premium would be 30 percent higher than the standard rate, and you would pay that extra amount for as long as you have Medicare.

Part B and Other Medicare Coverage

Part B works alongside other parts of Medicare. Part A covers hospital stays and some skilled nursing and home health care. Part D covers prescription drugs. Part B does not overlap with these — they cover different things. If you have a Medicare Advantage plan (Part C), you still have Part B coverage, but the plan may have different rules about which doctors you can see and how much you pay.

If you have a Medigap supplemental policy, it pays some or all of the costs that Part B does not cover — your deductible, coinsurance, and copays. This can significantly lower your out-of-pocket costs. Medigap is sold by private insurance companies, not by Medicare.

Frequently Asked Questions

Does Part B cover my annual physical exam?

Yes. Part B covers one yearly wellness visit with your doctor at no cost to you. This is different from a sick visit. During the wellness visit, your doctor reviews your health history, checks your vital signs, and may order preventive screenings. You do not pay the 20 percent coinsurance for this visit.

If my doctor orders a test, does Part B always pay for it?

Part B pays for tests that Medicare considers medically necessary. Your doctor must order the test, and it must be reasonable and necessary to diagnose or treat your condition. If Medicare decides a test was not medically necessary, it may deny the claim and you could be billed. Ask your doctor if a test is covered before you have it done.

Does Part B cover my prescriptions?

No. Prescription drugs are covered under Part D, which is separate from Part B. Part B covers some injectable drugs and infusions given in a doctor's office or clinic, but oral medications you take at home are covered under Part D. You must sign up for Part D separately, usually when you turn 65.

What happens if I turn down Part B and change my mind later?

You can sign up during the General Enrollment Period, which runs from January 1 to March 31 each year. Coverage begins July 1. However, you will pay a permanent penalty on your premium for each year you were may be able to access but did not sign up. The penalty is 10 percent of the standard premium per year.

Does Part B cover telehealth visits?

Yes. Part B covers video visits with your doctor or other providers when medically appropriate. You pay the same 20 percent coinsurance as you would for an in-person visit. Not all providers offer telehealth, so ask your doctor's office whether they do.