Medicare Part B covers doctor visits, outpatient care, and preventive services
Medicare Part B is the medical insurance portion of Original Medicare. It covers visits to doctors and specialists, lab tests, imaging like X-rays and ultrasounds, outpatient surgery, mental health treatment, and preventive care such as 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 like nursing homes or assisted living.
Part B requires a monthly premium, currently around $165 to $560 depending on your income, though the exact amount changes each year. You also pay a yearly deductible before Part B starts covering costs, and then you typically pay 20 percent of the approved amount for most services after that. Understanding what Part B covers helps you know what out-of-pocket costs to expect and whether you need additional coverage.
Key Takeaways
- Part B covers doctor office visits, specialist consultations, lab work, imaging, and outpatient procedures, but not hospital inpatient stays or prescription drugs.
- You pay a monthly premium for Part B, a yearly deductible, and then 20 percent coinsurance for most services after the deductible is met.
- Preventive services like annual wellness visits, cancer screenings, and flu shots are covered at no cost to you under Part B.
- Part B does not cover routine dental, vision, or hearing care, though some Medicare Advantage plans may offer limited coverage for these services.
Doctor visits and specialist care covered by Part B
Part B covers visits to your primary care doctor, cardiologists, orthopedic surgeons, neurologists, and other specialists. This includes office visits, consultations, and follow-up appointments. When you see a doctor who accepts Medicare, you pay your share of the cost after you meet your yearly deductible.
If you see a doctor who does not accept Medicare assignment, you may pay more out of pocket. Some doctors are "non-participating," meaning they do not have a contract with Medicare. Before your visit, ask whether the doctor accepts Medicare and whether they accept assignment — this tells you what your actual bill will be.
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, ultrasounds, CT scans, MRI scans, and other imaging services when medically necessary. These services must be ordered by a doctor and performed at a facility that accepts Medicare.
You pay 20 percent of the approved amount for these services after you meet your yearly deductible. If the facility is out-of-network or does not accept Medicare assignment, your costs may be higher. Always ask ahead whether the lab or imaging center accepts Medicare to avoid surprise bills.
Preventive care and screenings at no cost
Part B covers many preventive services with no cost to you — meaning you do not pay the deductible or coinsurance. These include an annual wellness visit with your doctor, colorectal cancer screening, mammograms, prostate screening, diabetes screening, and bone density screening. Flu shots, pneumonia vaccines, and the shingles vaccine are also covered at no cost.
These services must be ordered by your doctor and performed at an in-network provider. The "no cost" benefit applies only when the service is preventive — if your doctor finds something during a screening and performs a treatment, you may owe coinsurance for the treatment portion. Ask your doctor which preventive services you need based on your age and health history.
Outpatient surgery and procedures
Part B covers outpatient surgery performed at a hospital outpatient department or ambulatory surgery center. This includes procedures like cataract removal, joint injections, minor skin procedures, and endoscopies. You pay 20 percent of the approved amount after your deductible, unless the facility is out-of-network.
Outpatient means you go home the same day — you are not admitted to the hospital overnight. If your procedure requires an overnight hospital stay, that cost falls under Part A (hospital insurance) instead. Before scheduling, confirm with the facility whether the procedure is classified as outpatient and whether they accept Medicare.
Mental health and therapy services
Part B covers visits to psychiatrists, psychologists, clinical social workers, and other mental health providers. This includes therapy sessions, psychiatric evaluations, and medication management. You pay 20 percent of the approved amount after your deductible, the same as for other doctor visits.
Some mental health providers do not accept Medicare or do not accept assignment. Before starting treatment, ask whether the provider accepts Medicare and what your out-of-pocket cost will be. If you need ongoing therapy, confirm that the provider will continue accepting Medicare for your care.
What Part B does not cover
Part B does not cover routine dental care, eye exams for glasses or contacts, or hearing aids. It does not cover long-term care in a nursing home or assisted living facility. Part B also does not cover prescription drugs you take at home — those are covered under Part D. Cosmetic surgery, weight loss surgery (unless medically necessary), and most alternative therapies are not covered.
Part B does not cover services you receive outside the United States, except in limited circumstances near the U.S. border or on a cruise ship near U.S. ports. If you travel abroad, you may want supplemental coverage. Part B also does not cover services that are not medically necessary or that your doctor does not order.
How much you pay: premiums, deductibles, and coinsurance
The Part B monthly premium varies by income. Most people pay around $165 per month, but if your income is higher, you pay more. The amount is set each year and announced in the fall. You also pay a yearly deductible — the amount you must pay out of pocket before Part B starts covering costs — which changes annually.
After you meet the deductible, you typically pay 20 percent coinsurance for most Part B services. For preventive services with no cost sharing, you pay nothing. If you see a provider who does not accept assignment, you may pay more than 20 percent. Some people buy a Medigap policy to cover the deductible and coinsurance, which reduces their out-of-pocket costs.
Frequently Asked Questions
Does Part B cover my annual physical exam?
Yes. Part B covers one annual wellness visit per year at no cost to you. This is different from a traditional physical — it focuses on preventive care and creating a plan for your health. If your doctor performs additional services during the visit, you may owe coinsurance for those services.
What happens if I see a doctor who does not accept Medicare?
You can still see the doctor, but you will likely pay more out of pocket. Non-participating doctors can charge up to 15 percent more than the Medicare-approved amount. Ask the doctor's office about their Medicare status and fees before your visit to understand your costs.
Does Part B cover prescription medications?
No. Prescription drugs you take at home are covered under Part D, which is a separate insurance plan. Part B covers medications given to you during an office visit or outpatient procedure. If you need Part D coverage, you can enroll during the annual enrollment period or when you first become may be able to access for Medicare.
Are dental and vision care covered under Part B?
Routine dental care, eye exams for glasses, and hearing aids are not covered by Part B. Some Medicare Advantage plans offer limited dental or vision coverage, but Original Medicare does not. You can purchase standalone dental and vision insurance if you need this coverage.
What if I cannot afford my Part B costs?
If your income is low, you may be able to get help paying your Part B premium through the Medicare Savings Programs, which are run by your state. You can also buy a Medigap policy to help cover deductibles and coinsurance, though Medigap has its own premiums and rules about when you can enroll.