Medicare Part B covers doctor visits and outpatient care, but it has real gaps

Medicare Part B pays for visits to your doctor, outpatient hospital services, diagnostic tests, and some medical equipment — but it stops short in several places where you might expect coverage. Understanding what Part B does not cover helps you plan for costs and know when you need other insurance or out-of-pocket money.

The gaps fall into a few patterns: services that Medicare considers preventive or routine but not medically necessary, care that happens in certain settings, and treatments that fall outside the program's scope entirely. Knowing the difference between what Part B covers and what it does not can save you from surprise bills.

Key Takeaways

  • Medicare Part B does not cover routine dental care, eye exams for glasses, or hearing aids, even though these services affect your health and independence.
  • Long-term care in a nursing home or assisted living facility is not covered by Part B; you need separate insurance or to pay out of pocket.
  • Prescription drugs are not covered under Part B alone — you need Part D coverage or a Part C plan that includes drug benefits.
  • Services like acupuncture, massage therapy, and most cosmetic procedures are excluded unless your doctor documents a specific medical reason.
  • Routine foot care, eye exams for refraction, and most chiropractic care fall outside Part B coverage in most situations.

Dental, vision, and hearing services Part B will not pay for

Medicare Part B does not cover routine dental work — cleanings, fillings, extractions, dentures, or root canals. The only exception is a dental procedure that becomes necessary because of a covered medical condition, such as jaw surgery after an accident. Even then, the dental work itself is not covered; only the underlying medical treatment is.

Vision care has similar limits. Part B covers one eye exam every two years if you have diabetes or a history of glaucoma, and it covers glasses or contact lenses after cataract surgery. It does not cover routine eye exams for refraction (to determine your prescription), bifocals, progressive lenses, or frames. Hearing aids and hearing exams for the purpose of fitting hearing aids are also excluded, though Part B does cover a diagnostic hearing test if your doctor orders it for a medical reason.

Many people buy separate dental and vision insurance through their employer, a retiree plan, or a private insurer. Others budget for these costs out of pocket or look into dental discount plans, which are not insurance but offer reduced rates at participating providers. Some Part C plans (Medicare Advantage) include dental or vision benefits, so comparing those options alongside Original Medicare can show you what fits your needs.

Long-term care and custodial services

Medicare Part B does not cover nursing home care, assisted living, or in-home custodial care — help with bathing, dressing, meals, or medication reminders. Part B covers skilled nursing care only, and only after a hospital stay of at least three days, for a limited time (up to 100 days per benefit period), and only at a facility Medicare certifies.

If you need ongoing help with daily activities, you pay for it yourself, through Medicaid (if you meet income and asset limits), through long-term care insurance, or through family support. Some people use a combination: Medicare covers the skilled nursing portion after hospitalization, and they or their family pay for the custodial care that follows. Planning ahead — whether through insurance, savings, or family conversations — makes a real difference when this care becomes necessary.

Prescription drugs without Part D or Part C

Part B itself does not cover outpatient prescription drugs. If you have Original Medicare (Part A and Part B), you must enroll in Part D (prescription drug coverage) through a private plan, or choose a Part C plan (Medicare Advantage) that includes drug benefits. Without one of these, you pay the full pharmacy price for medications.

Part B does cover some drugs given to you in a doctor's office or hospital outpatient setting — for example, chemotherapy or certain injections — but not the pills or liquids you take at home. If you miss the important date to enroll in Part D when you first become may be able to access, you may face a permanent penalty on your premiums. The initial enrollment period is three months before and three months after the month you turn 65, so marking that window on your calendar matters.

Therapies and treatments with limited or no coverage

Acupuncture, massage therapy, and chiropractic care have narrow coverage under Part B. Acupuncture is covered only for chronic lower back pain, up to 20 visits per year, and only if your doctor refers you. Chiropractic care is limited to manipulation of the spine for subluxation (misalignment), and only if an X-ray documents the problem. Massage therapy is not covered at all.

Routine foot care — cutting toenails, removing corns or calluses — is not covered unless you have diabetes or a circulatory condition that makes foot care a medical necessity. Cosmetic procedures, including most plastic surgery, are excluded. Naturopathy, homeopathy, and most herbal treatments are not covered.

Some of these services may be covered under a Part C plan (Medicare Advantage), which can offer benefits beyond Original Medicare. If you use these therapies, ask your doctor whether a medical reason exists that might change the coverage picture, and check your specific plan's rules. Documenting a medical need with your doctor before seeking treatment sometimes opens coverage that would otherwise be denied.

Routine preventive care that Part B does not cover

Part B covers many preventive services at no cost to you — mammograms, colonoscopies, blood pressure checks, and certain vaccines. But it does not cover routine physical exams or annual wellness visits that are purely routine. It also does not cover preventive services that are not on Medicare's approved list, even if your doctor recommends them.

The line between covered and uncovered prevention can be confusing. For example, Part B covers a one-time abdominal aortic aneurysm screening if you meet certain risk factors, but it does not cover routine screening for other conditions unless they are on the approved list. Your doctor's office can tell you whether a specific test or service is covered under your plan, and asking before you schedule saves time and money.

Medical equipment and supplies with restrictions

Part B covers durable medical equipment — wheelchairs, walkers, oxygen, hospital beds — but only if your doctor prescribes it and it meets Medicare's definition of medically necessary. It does not cover equipment for convenience or comfort, such as a lift chair or a seat cushion unless there is a documented medical reason.

Diabetic supplies like test strips and lancets are covered, but only if you use insulin or certain other medications. Routine supplies like bandages, heating pads, or compression stockings are generally not covered. Replacement equipment is covered only if the original has been used for the required time period (usually five years for major equipment). Keeping records of when you received equipment helps you know when you can request a replacement.

Services outside the United States

Medicare Part B does not cover medical care you receive outside the United States, except in very limited cases: if you are in Canada or Mexico and the nearest hospital is in the United States, or if you are traveling directly between Alaska and another U.S. state and need emergency care in Canada. Retirees who spend winters abroad or travel internationally should consider supplemental travel insurance or a plan that covers out-of-country care.

If you travel frequently or spend extended time outside the U.S., talk to your insurance agent about options before you leave. Some travel insurance plans cover emergency medical care abroad, and some Part C plans have out-of-country coverage. Planning ahead prevents a medical emergency from becoming a financial crisis.

Frequently Asked Questions

Does Medicare Part B cover glasses or contacts?

Part B covers one pair of glasses or contact lenses after cataract surgery. It does not cover routine eye exams for a prescription, bifocals, progressive lenses, or replacement glasses. Many people buy vision insurance separately or pay out of pocket for routine eye care.

What if I need a nursing home after I leave the hospital?

Part B covers skilled nursing care in a Medicare-certified facility for up to 100 days per benefit period, but only if you spent at least three days in the hospital first. After that, you pay the full cost unless you have long-term care insurance or Medicaid. Custodial care — help with daily activities — is never covered by Part B.

Are prescription drugs covered under Part B?

Outpatient prescription drugs are not covered by Part B alone. You need Part D (a separate prescription drug plan) or a Part C plan (Medicare Advantage) that includes drug coverage. Drugs given to you in a doctor's office or hospital are covered by Part B.

Can Part B cover acupuncture or chiropractic care?

Part B covers acupuncture only for chronic lower back pain, up to 20 visits per year with a doctor's referral. Chiropractic care is covered only for spine manipulation if an X-ray shows misalignment. Massage therapy is not covered. Coverage varies by plan, so check your specific benefits.

What happens if I need medical care while traveling outside the U.S.?

Medicare Part B does not cover care outside the United States except in rare cases (emergency care in Canada while traveling between Alaska and the mainland). If you travel internationally, consider supplemental travel insurance or a plan that covers out-of-country medical care.