Part B covers doctor visits, lab tests, imaging, and outpatient hospital services

Medicare Part B is the insurance that pays for services you receive outside a hospital — mainly visits to doctors and specialists, diagnostic tests, imaging like X-rays and ultrasounds, and procedures done in outpatient clinics. It also covers some equipment and supplies your doctor orders, like wheelchairs or diabetic testing strips. Part B is optional, but most people who have Part A also enroll in Part B because the two work together to cover most of what happens when you need medical care.

Part B requires a monthly premium, which varies by income. You pay a portion of each service (called a copay or coinsurance) after you meet your annual deductible. Unlike Part A, which covers hospital stays, Part B is the piece that keeps you covered when you're seeing doctors in their offices, urgent care centers, or outpatient departments.

Key Takeaways

  • Part B covers doctor office visits, specialist consultations, preventive care screenings, and lab work with no copay for many preventive services.
  • Imaging and diagnostic tests — including X-rays, CT scans, ultrasounds, and EKGs — are covered under Part B when ordered by your doctor.
  • Outpatient hospital services, emergency room visits, and same-day surgery centers are covered; Part B pays its share after you meet your deductible.
  • Durable medical equipment like oxygen, walkers, hospital beds, and diabetic supplies are covered when prescribed by a doctor.
  • You pay a monthly premium for Part B, plus a deductible and coinsurance for most services, though preventive visits often have no out-of-pocket cost.

Doctor visits and specialist care

Part B covers visits to your primary care doctor, cardiologists, orthopedists, neurologists, and any other specialist your doctor refers you to. The visit itself is covered — whether it's a routine checkup, a follow-up for a chronic condition, or an evaluation for a new symptom. You pay coinsurance (usually 20% of the approved amount) after you've met your annual deductible.

Preventive visits — like annual wellness exams and certain screenings — have no copay or coinsurance under Part B. These include blood pressure checks, cholesterol screening, diabetes screening, and cancer screenings like mammograms and colonoscopies when they're done for prevention rather than diagnosis of a known problem. If your doctor finds something during a preventive visit and needs to do additional testing or treatment, that additional service may have a cost.

Lab tests, imaging, and diagnostic services

When your doctor orders blood work, urinalysis, or other lab tests, Part B covers the cost of the test itself. You pay coinsurance after your deductible. This includes routine tests like cholesterol panels, thyroid function tests, and blood glucose monitoring, as well as more specialized tests your doctor orders to diagnose or monitor a condition.

Imaging services — X-rays, CT scans, MRI scans, ultrasounds, and nuclear medicine scans — are covered under Part B when your doctor orders them. EKGs and other cardiac monitoring are also covered. Part B pays its share; you pay coinsurance. The amount you pay depends on where the imaging is done (hospital outpatient department, independent imaging center, or doctor's office) because the facility fees vary.

Outpatient hospital and emergency services

If you receive care at a hospital outpatient department — for example, a same-day surgery, an infusion, or an emergency room visit — Part B covers the facility costs. You pay coinsurance for these services. Emergency room visits are covered whether you're admitted to the hospital afterward or sent home; Part B pays its share of the emergency department charge.

Urgent care centers and ambulatory surgery centers are also covered under Part B. If you have a procedure like a cataract removal, a biopsy, or joint injection done in an outpatient setting, Part B covers the facility and the surgeon's fee. You'll pay your deductible and coinsurance.

Durable medical equipment and supplies

Part B covers durable medical equipment — items that are ordered by your doctor and meant to last at least three years. This includes wheelchairs, walkers, canes, crutches, hospital beds, oxygen equipment, CPAP machines, and nebulizers. You typically pay 20% coinsurance after your deductible for equipment. Some equipment requires prior authorization from Medicare before you purchase it, so ask your doctor or supplier to check with Medicare first.

Diabetic supplies are also covered: test strips, lancets, glucose monitors, and insulin pumps. Ostomy supplies, wound care supplies, and other medical supplies ordered by your doctor are covered under Part B. Coverage rules vary by item, so it's worth checking with Medicare or your supplier about what's covered for your specific situation.

Mental health and therapy services

Part B covers visits to psychiatrists, psychologists, clinical social workers, and counselors for mental health treatment. You pay coinsurance after your deductible, the same as you would for a medical doctor visit. This includes therapy for depression, anxiety, grief, and other mental health conditions.

Physical therapy, occupational therapy, and speech-language pathology are also covered under Part B when ordered by your doctor. These services may be provided in a clinic, a hospital outpatient department, or sometimes at home. Part B covers up to a certain number of visits per year for each type of therapy, though your doctor can request exceptions if medically necessary.

What Part B does not cover

Part B does not cover routine dental care, eye exams for glasses or contacts, hearing aids, or routine foot care (though it covers foot care if you have diabetes). Prescription drugs filled at a pharmacy are not covered by Part B; that's what Part D is for. Cosmetic procedures, weight loss surgery, and most fertility treatments are not covered.

Long-term care in a nursing home or assisted living facility is not covered by Part B. Services from providers outside the United States are generally not covered, except in limited situations. If you travel abroad, check with Medicare before you go to understand what care, if any, would be covered.

How costs work under Part B

Part B has three cost layers: the monthly premium, the annual deductible, and coinsurance. The premium is withheld from your Social Security check (or you pay it directly if you don't receive Social Security). The deductible is a set amount you pay out of pocket each year before Part B starts paying; once you've met it, you pay coinsurance on most services.

Coinsurance is usually 20% of the Medicare-approved amount for the service. So if a doctor visit is approved at $100, you pay $20 and Part B pays $80. If you see an out-of-network provider who doesn't accept Medicare assignment, you may pay more. If you have a Medigap or Medicare Advantage plan, that plan may cover some or all of your coinsurance, depending on the plan.

Frequently Asked Questions

Do I have to pay anything for preventive care visits?

No. Annual wellness exams, cancer screenings, and certain other preventive services covered by Part B have no copay or coinsurance. However, if your doctor finds something during the visit and performs additional testing or treatment, you may owe coinsurance for that additional service.

What happens if I see a doctor who doesn't accept Medicare?

If a doctor doesn't accept Medicare assignment, you may have to pay the full bill upfront and request reimbursement, or pay more than the standard coinsurance. It's best to confirm your doctor accepts Medicare before your visit. You can search for Medicare-participating providers on Medicare.gov.

Does Part B cover physical therapy at home?

Yes, Part B covers physical therapy, occupational therapy, and speech therapy ordered by your doctor, including services provided in your home. You pay coinsurance after your deductible. Medicare limits the number of visits per year, though your doctor can request an exception if medically necessary.

Are prescription medications covered by Part B?

No. Prescription drugs you fill at a pharmacy are covered by Part D (prescription drug coverage), not Part B. Part B covers some medications given by injection or infusion in a doctor's office or hospital outpatient setting, but not oral medications you take at home.

What if I haven't met my Part B deductible yet?

Until you meet your annual deductible, you pay the full approved amount for most Part B services. Once you've paid the deductible amount, you then pay coinsurance (usually 20%) for the rest of the year. The deductible resets on January 1 each year.