What Does Medicare Part B Cover?

If Medicare were a four-part TV series, Part B would be the episode where most of the action happens.
It’s the part that helps pay for doctor visits, outpatient care, tests, and the long list of preventive services that keep little health issues from turning into big (and expensive) ones.
But exactly what does Medicare Part B coverand what will you pay?

In this guide, we’ll walk through the main Medicare Part B benefits, what’s not covered, how costs work,
and a few real-life examples so you can see how this coverage plays out in everyday life.
Whether you’re approaching 65, already enrolled, or helping a parent figure this out, you’ll come away with a clear, practical understanding of Medicare Part B coverage.

Quick Overview: What Is Medicare Part B?

Medicare Part B is the “medical insurance” side of Original Medicare. While Part A focuses on inpatient hospital and skilled nursing facility stays,
Part B helps cover medically necessary services you get as an outpatientplus a growing list of preventive care and screenings.

In simple terms, Medicare Part B usually covers:

• Services from doctors and other health care providers
• Outpatient care, including same-day surgeries and emergency room follow-up
• Medically necessary lab tests, X-rays, and imaging
• Preventive services like vaccines, screenings, and annual wellness visits
• Durable medical equipment (DME), such as walkers or home oxygen
• Certain home health services
• Some outpatient drugs, such as injections and infusions you get in a clinic
• Telehealth visits that meet Medicare rules

All of this comes with a monthly premium, an annual deductible, and usually 20% coinsurance for most covered services once that deductible is met.

Major Categories of Medicare Part B Coverage

1. Doctor and Other Health Care Provider Services

Doctor visits are one of the core Medicare Part B benefits. This includes appointments with:

• Primary care physicians (for checkups, follow-ups, and chronic condition management)
• Specialists (such as cardiologists, dermatologists, or neurologists)
• Nurse practitioners and physician assistants
• Some mental health professionals, like psychiatrists and certain clinical psychologists

If the service is medically necessary and your provider accepts Medicare, Part B typically covers 80% of the Medicare-approved amount after you meet the annual Part B deductible.
You usually pay the remaining 20%.

2. Outpatient Hospital Care and Same-Day Procedures

Not all hospital care means an overnight stay. When you’re treated in a hospital or outpatient facility but are not admitted as an inpatient,
those services usually fall under Medicare Part B. Examples include:

• Same-day surgeries (for example, cataract removal)
• Emergency room visits where you’re treated and released
• Observation stays
• Outpatient clinic visits and infusion centers

These services are covered under Part B, again with the usual deductible and coinsurance rules.

3. Preventive Care and Screening Services

One of the biggest shifts in Medicare over the last decade has been its strong emphasis on preventive care.
Medicare Part B covers many preventive services at no cost to you, as long as your provider accepts Medicare assignment.

Examples of Part B preventive services include:

• “Welcome to Medicare” preventive visit – once within the first 12 months you have Part B
• Annual wellness visit – a yearly check-in focused on prevention and planning, not a head-to-toe physical exam
• Flu, COVID-19, and other recommended vaccines
• Screenings for conditions such as diabetes, depression, certain cancers, and cardiovascular disease
• Bone density tests for people at risk of osteoporosis
• Alcohol misuse and tobacco use counseling

For most of these Medicare Part B preventive services, you’ll pay nothing if the service is truly preventive and not part of a diagnostic follow-up.
If during a “free” screening your doctor finds something that needs additional testing or treatment, the follow-up care may involve standard Part B costs.

4. Mental Health Services (Outpatient)

Medicare Part B covers a range of outpatient mental health services. These may include:

• Individual and group therapy
• Diagnostic evaluations
• Medication management visits with a psychiatrist
• Partial hospitalization programs (structured outpatient programs as an alternative to full hospitalization)

You’ll typically pay the Part B deductible and then 20% of the Medicare-approved amount for covered mental health services,
as long as your provider accepts Medicare.

5. Durable Medical Equipment (DME)

When you need medically necessary equipment to use at home, Medicare Part B may help.
DME must be ordered by your doctor and supplied by a Medicare-enrolled supplier. Examples include:

• Walkers and wheelchairs
• Hospital beds for home use
• Home oxygen equipment
• Continuous positive airway pressure (CPAP) machines for sleep apnea
• Blood glucose monitors for people with diabetes

In most cases, you pay 20% of the Medicare-approved amount after meeting the deductible, and Medicare pays the remaining 80%.

6. Limited Home Health Care

Medicare Part B also covers certain home health services if you meet eligibility rules. These services are typically for people who are “homebound” and need skilled care.
Covered home health services may include:

• Part-time or intermittent skilled nursing care
• Physical, occupational, and speech therapy
• Medical social services
• Some home health aide services, when combined with skilled care

If you qualify, home health services may have low or no out-of-pocket costs under Part B, though you may still pay 20% for certain medical equipment or supplies.

7. Some Outpatient Drugs and Infusions

While routine prescriptions are usually covered under Medicare Part D (or a Medicare Advantage drug plan),
Medicare Part B covers certain drugs in very specific situations.
These often include:

• Drugs you get by injection or infusion in a doctor’s office or outpatient clinic
• Certain cancer drugs and biologic therapies
• Some drugs used with DME, such as nebulizer solutions

When a drug is covered under Part B, it is usually treated like any other Part B serviceyou pay the deductible (if you haven’t met it yet) and then 20% coinsurance, with Medicare paying the rest.

8. Telehealth Visits

Telehealth exploded during the public health emergency, and Medicare has continued to cover many telehealth services when certain rules are met.
Depending on your situation, you may be able to see your doctor, certain specialists, or mental health providers via video (and sometimes audio-only) visits.

When the telehealth service qualifies as a covered Part B service, costs are usually the same as if you were seen in persondeductible, then 20% coinsurance.

What Does Medicare Part B Not Cover?

Just as important as knowing what Medicare Part B covers is knowing what it doesn’t. These gaps are often where people get surprised.

Medicare Part B generally does not cover:

• Most routine dental care, dentures, or cleanings
• Routine eye exams for glasses or contacts (with limited exceptions)
• Hearing aids and most hearing exams for fitting them
• Long-term custodial care in nursing homes
• Cosmetic surgery that isn’t medically necessary
• Most chiropractic services (beyond limited spinal manipulation)

To fill these gaps, many people pair Part B with a Medigap plan, employer coverage, Medicaid, or a Medicare Advantage plan that bundles extra benefits.

What You Pay Under Medicare Part B

Medicare Part B coverage is not free. Understanding the basic cost structure helps you avoid unpleasant surprises.

1. Monthly Premium

Almost everyone enrolled in Medicare Part B pays a monthly premium. For 2025, the standard Part B premium is $185 per month for most beneficiaries.
People with higher incomes may pay more due to an income-related monthly adjustment amount (IRMAA).

Premium amounts can change each year. For example, federal officials have already announced higher Part B deductibles and premiums for 2026,
driven in part by rising health care costs and utilization.

2. Annual Part B Deductible

Before Original Medicare starts paying for most Part B-covered services, you must meet a yearly deductible.
In 2025, the Part B deductible is $257.
You pay this amount out-of-pocket once per year. After that, Part B usually pays 80% of approved costs, and you pay 20%.

3. Coinsurance and Copayments

For most Medicare Part B benefits, you’ll pay:

• 20% coinsurance of the Medicare-approved amount for each service after you’ve met the deductible
• Possibly more if your provider does not accept Medicare assignment and can bill you extra within allowed limits

Some servicesespecially preventive caremay have no cost to you if specific conditions are met and your provider accepts Medicare assignment.

4. Help with Part B Costs

If Part B premiums or coinsurance are a stretch, there are potential options:

• Medicare Savings Programs (administered by state Medicaid agencies) may help pay Part B premiums and possibly other costs for people with limited income and resources.
• Medigap plans can help cover some or all of your Part B coinsurance and deductibles if you stay in Original Medicare.
• Medicare Advantage (Part C) plans often use copays instead of coinsurance and may offer a yearly out-of-pocket maximum.

It’s important to compare your options each year during open enrollment to make sure your coverage and costs still make sense for your situation.

How Medicare Part B Works with Other Coverage

Medicare Part B rarely operates in a vacuum. Many people have more than one type of coverage, such as:

• Employer or retiree coverage
• Veterans Affairs (VA) benefits
• TRICARE for military retirees
• Medicaid

In those cases, rules determine which coverage pays first (the “primary” payer) and which pays second (the “secondary” payer).
For example, if you’re still actively working and covered by an employer plan with 20 or more employees, that employer plan typically pays first and Medicare pays second.

Getting this coordination wrongsuch as delaying Part B when your employer coverage does not qualify as primarycan lead to late enrollment penalties and big bills.
When in doubt, it’s worth talking to Social Security, your benefits administrator, or a trusted counselor from your State Health Insurance Assistance Program (SHIP).

Tips for Getting the Most from Your Medicare Part B Coverage

• Use preventive services every year. Take advantage of annual wellness visits and screeningscatching problems early can protect both your health and your wallet.
• Choose providers who accept Medicare assignment. This helps limit extra charges and surprise bills.
• Review your coverage annually. Even if you keep Original Medicare, your Part D or Medicare Advantage options can change each year.
• Ask before a service is performed. If you’re unsure whether something is covered, ask your provider’s office or contact Medicare first.
• Keep records. Save your Explanation of Benefits (EOBs) and bills so you can spot errors or appeal denials if needed.

Medicare Part B coverage can look complicated on paper, but once you understand the basic patternpremium, deductible, then 80/20 cost-sharingit becomes much more manageable.

Real-World Experiences with Medicare Part B Coverage

Medicare Part B isn’t just a list of rulesit’s something people use every day. The stories below are fictional but based on common situations that show how Part B coverage actually works.

1. Linda’s “Welcome to Medicare” Visit

Linda turned 65 last spring. She’d always been healthy and hadn’t seen a doctor in a while, so she wasn’t exactly thrilled about adding more medical appointments to her life.
But her daughter kept nudging her: “Mom, Medicare Part B covers a ‘Welcome to Medicare’ visitjust go.”

Linda booked the appointment with a doctor who accepted Medicare. During the visit, they reviewed her medical history, checked her blood pressure, discussed her diet and exercise,
and ordered a few screening tests appropriate for her age. Because it was a Part B preventive visit and the provider accepted assignment, she paid $0 out-of-pocket for the visit itself.

One of the ordered screenings found early signs of osteoporosis. Thanks to Part B coverage, she could get a bone density test and start treatment early, likely preventing a serious fracture down the road.
For Linda, Part B coverage turned a reluctant appointment into a long-term health win.

2. James and the “Surprise” Outpatient Surgery Bill

James needed cataract surgery. His surgeon’s office explained that the procedure would be done as an outpatient surgery and that Medicare Part B would help pay for it.
He had already met his Part B deductible earlier in the year, so he’d owe about 20% of the Medicare-approved amount plus any facility fees.

The surgery went smoothly, but the bill that arrived later still made his heart skip a beat. After he calmed down, he looked more closely.
The Medicare Summary Notice showed what Medicare approved, what Part B paid, and what his responsibility was.
The original charges from the provider were much higher than the “Medicare-approved” amountsomething Part B had significantly reduced.

Once he understood this, James realized that Medicare Part B had actually saved him thousands of dollars off the provider’s list price.
It wasn’t that his bill was huge; it was that the original charge had been enormous.

3. Maria’s Telehealth Check-Ins

Maria lives in a rural area and manages diabetes and high blood pressure. Long drives to her specialist used to mean an entire day away from home.
After her clinic began offering telehealth visits covered under Medicare Part B, her life got easier.

Now she has regular video visits where her doctor reviews her blood sugar logs, checks in about her medications, and answers questions.
The visits are billed like an in-person Part B visit: she meets her annual deductible, then pays 20% coinsurance for each telehealth visit that Medicare covers.

The convenience has made a huge difference. Maria is more consistent with appointments and lab work, which means better control of her conditions and fewer emergency trips to the hospital.
In her words, “Part B didn’t just cover a video callit helped me stay on top of my health.”

4. Robert’s Experience with Durable Medical Equipment

After a fall, Robert needed a walker and later a lightweight wheelchair while he recovered. His doctor wrote a prescription and sent it to a supplier that participates in Medicare.

Because the equipment qualified as durable medical equipment under Part B rules, Medicare approved 80% of the cost after his deductible was met.
Robert paid the remaining 20%. Without Part B, his out-of-pocket cost would have been hundreds of dollars higher.

The walker and wheelchair weren’t glamorous purchasesbut they made it possible for him to stay at home safely while he regained strength,
rather than moving to a facility for rehabilitation. For Robert, Medicare Part B coverage helped support both his independence and his budget.

5. What These Experiences Have in Common

These examples look differentpreventive care, surgery, telehealth, and durable medical equipmentbut the underlying pattern is the same:

• Part B steps in to cover medically necessary outpatient and preventive care.
• Patients often pay a predictable share of the Medicare-approved amount (usually 20% after the deductible).
• Choosing providers and suppliers who work with Medicare makes the coverage smoother and more affordable.

When you understand what Medicare Part B coversalong with what it doesn’tit’s easier to plan your care, budget for your costs, and avoid unpleasant surprises.
And while the rules can be a little dry, the bottom line is simple: Part B is often what keeps everyday health care from becoming financially overwhelming.

Conclusion

Medicare Part B covers a wide range of outpatient services, from routine doctor visits and preventive screenings to mental health care, telehealth services, and durable medical equipment.
You’ll pay a monthly premium, meet an annual deductible, and then typically owe 20% coinsurance for most covered services when using providers who accept Medicare.

Understanding your Medicare Part B benefitsand pairing them with the right additional coverage, like Medigap, Part D, or Medicare Advantagecan help you protect both your health and your finances.
When in doubt, ask questions, use preventive services, and review your coverage each year so Part B works as hard for you as you’ve worked to earn it.