Answers

What does Medicare Part B cover?

Part B pays for much of the care you get outside a hospital stay, and its limits and cost rules matter as much as the list of what's in.

Arun Verma, co-founder of Triangle · 2026-10-19

This is not clinical evidence and not medical advice. It does not replace your care team. Discuss anything here with your clinician before you act on it.

What does Medicare Part B cover?

Part B is Medicare's medical insurance, and it helps cover two kinds of care: medically necessary services and preventive services. In practice that means services from doctors and other health care providers, outpatient care, home health care, durable medical equipment such as walkers and hospital beds, and many preventive services like screenings and shots. Medically necessary, in Medicare.gov's words, means services or supplies that meet accepted standards of medical practice to diagnose or treat your medical condition. The Medicare & You handbook adds limited outpatient prescription drugs and other medical services to the list. If you're in a Medicare Advantage Plan, the plan must cover all medically necessary services that Original Medicare covers, even though its rules can differ.

Which doctors and outpatient services does Part B cover?

Doctor services and many services you get as an outpatient. Part B covers medically necessary services from doctors, meaning MDs and DOs and, in some cases, a podiatrist, optometrist or chiropractor. It also covers other providers such as nurse practitioners, physician assistants, physical and occupational therapists and speech-language pathologists, plus some doctor services you get while you're a hospital inpatient. At a hospital, Part B covers many diagnostic and treatment services you get as an outpatient. Medicare.gov lists emergency or observation services, which may include an overnight stay, along with same-day surgery, lab tests and X-rays billed by the hospital, and medical supplies such as splints and casts. Ambulance services and oxygen equipment are on the Part B list too.

Which preventive services does Part B cover?

Many, and most cost you nothing when the provider accepts assignment. Medicare.gov describes preventive services as exams, vaccines, lab tests and screenings, plus counseling and education to help you take care of your own health. Its Part B list runs long and includes flu and pneumococcal vaccines, bone mass measurements and counseling to prevent tobacco use. Part B also covers one "Welcome to Medicare" preventive visit within your first 12 months of Part B, a one-time check-up that isn't a comprehensive physical exam. There is a catch the handbook spells out. For some preventive services you may pay a deductible, coinsurance or both, and extra tests or services during a preventive visit can bring the Part B deductible and coinsurance into play. A fair question when you book is which parts of the visit count as preventive.

Does Part B cover medical equipment for home?

Yes, when it's medically necessary and your doctor or other provider orders it for use in your home. Medicare.gov defines durable medical equipment as equipment that can withstand repeated use, is used for a medical reason, is typically only useful to someone who is sick or injured, is used in your home and is expected to last at least 3 years. Its examples include canes, crutches, walkers, wheelchairs and scooters, hospital beds and oxygen equipment. Depending on the item, you may need to rent it, buy it, or be able to choose. Medicare only pays for equipment from suppliers enrolled in Medicare, so you could ask a supplier whether it participates in Medicare or accepts assignment before you get anything.

Does Part B cover prescription drugs?

Only a limited number, under certain conditions. Usually Part B covers drugs you wouldn't typically give to yourself, like those you get at a doctor's office or in a hospital outpatient setting, and Medicare.gov says it covers most injectable and infused drugs when a licensed provider gives them. Drugs you take yourself are mostly outside Part B. Generally, Part B doesn't cover prescription and over-the-counter drugs you get in an outpatient setting, sometimes called self-administered drugs. Medicare drug coverage, called Part D, covers many drugs that Part B doesn't, and Medicare.gov says Part D generally covers the adult vaccines the ACIP recommends, such as shingles and RSV vaccines.

What doesn't Part B cover?

Some everyday care sits outside Original Medicare. The handbook's list includes non-medical long-term care, eye exams for prescription eyeglasses, hearing aids and exams for fitting them, routine physical exams, cosmetic surgery, massage therapy and concierge care. Most dental care is out too, such as routine cleanings, fillings, extractions and dentures, though Original Medicare may pay for some dental services closely related to certain covered services. Non-medical long-term care means personal care, like help with dressing and bathing. If you need something Part A and Part B don't cover, you pay for it yourself unless other coverage helps. Medicare Advantage Plans may offer extra benefits such as vision, hearing and dental services.

How are Part B costs set up?

In three pieces: a monthly premium, a yearly deductible and coinsurance after that. You pay the premium each month even if you don't use any Part B services, and Medicare.gov says the amount can change each year. Most people pay the standard amount. The handbook explains that Medicare uses the income on your tax return from 2 years ago to decide whether you pay an extra charge, and if you get Social Security benefits the premium comes out of your monthly payment. The deductible is paid once each year, before Original Medicare starts to pay. After that, you typically pay 20% of the Medicare-approved amount for covered services when the provider accepts assignment. Hospital outpatient care usually adds a copayment to the hospital for each service. Original Medicare has no yearly limit on what you pay out of pocket. This page leaves out dollar amounts; the handbook points to Medicare.gov for the latest premium amount and income limits.

Why does it matter whether a doctor accepts assignment?

Because it changes what you pay. A provider who accepts assignment takes the Medicare-approved amount as full payment, charges you only the deductible and coinsurance, and sends the claim to Medicare directly. Most doctors and suppliers accept assignment, and Medicare.gov suggests checking that yours do. A provider who doesn't accept assignment can charge more than the approved amount, in many cases up to 15% more, a cap Medicare calls the limiting charge. You might also have to pay the full amount at the time of service. Medicare won't pay at all for care from a provider who has opted out of Medicare, except in emergencies.

How can I tell whether a specific test or service is covered?

The handbook points to a coverage search on Medicare.gov and to 1-800-MEDICARE. How often you get something can matter too: Medicare may cover some services and tests more often than described if your doctor needs them to diagnose or treat your condition. Part B still leaves gaps: some services a clinician recommends are never covered, or are covered less often than recommended. Ask what the visit is for, whether Part B pays for that code, and what coinsurance or deductible you will owe. Your secondary plan, whether the clinician accepts assignment, and the site of care (office vs hospital outpatient) can change the bill.

Sources

• Medicare.gov: What Part B covers: Medicare.gov says Medicare Part B (Medical Insurance) helps cover 2 types of services: medically necessary services and preventive services.
• Medicare.gov: Parts of Medicare: Medicare.gov says Part B helps cover services from doctors and other health care providers, outpatient care, home health care, durable medical equipment (like wheelchairs, walkers, hospital beds and other equipment) and many preventive services (like screenings, shots or vaccines, and yearly "Wellness" visits).
• Medicare.gov: What Part B covers: Medicare.gov describes medically necessary services as services or supplies that meet accepted standards of medical practice to diagnose or treat your medical condition.
• CMS: Medicare & You 2027, the official U.S. government Medicare handbook (p. 32): The Medicare & You handbook says Part B helps cover, among other services, medically necessary doctor's services, outpatient care, some home health services, durable medical equipment, limited outpatient prescription drugs and other medical services, and that Part B also covers many preventive services.
• CMS: Medicare & You 2027, the official U.S. government Medicare handbook (p. 12): The Medicare & You handbook says Medicare Advantage Plans must cover all medically necessary services that Original Medicare covers.
• Medicare.gov: What Part B covers: Medicare.gov says that if you're in a Medicare Advantage Plan or other Medicare plan, your plan may have different rules, but must give you at least the same coverage as Original Medicare.
• Medicare.gov: Doctor & other health care provider services: Medicare.gov says a doctor can be a Doctor of Medicine (MD), a Doctor of Osteopathic Medicine (DO) or, in some cases, a podiatrist, optometrist or chiropractor, and that Medicare also covers services from other health care providers such as nurse practitioners, physician assistants, physical therapists, occupational therapists and speech-language pathologists.
• Medicare.gov: Doctor & other health care provider services: Medicare.gov says Part B covers medically necessary doctor services, including outpatient services and some inpatient hospital doctor services you get when you're a hospital inpatient.
• Medicare.gov: Outpatient hospital services: Medicare.gov says Part B covers many diagnostic and treatment services you get as an outpatient from a hospital that takes Medicare, and that covered outpatient hospital services may include emergency or observation services (which may include an overnight stay in the hospital, or services in an outpatient clinic including same-day surgery), laboratory tests and X-rays billed by the hospital, and medical supplies like splints and casts.
• Medicare.gov: What Part B covers: Medicare.gov's list of things Part B covers includes ambulance services and oxygen equipment and accessories.
• Medicare.gov: Preventive & screening services: Medicare.gov says preventive services include exams, vaccines, lab tests and screenings, and also counseling and education to help you take care of your own health.
• Medicare.gov: Preventive & screening services: Medicare.gov's list of Part B preventive services includes, among many others, flu vaccines, pneumococcal vaccines, bone mass measurements, and counseling to prevent tobacco use and tobacco-caused disease.
• Medicare.gov: Preventive & screening services: Medicare.gov says you pay nothing for most preventive services if you get the services from a health care provider who accepts assignment.
• Medicare.gov: "Welcome to Medicare" preventive visit: Medicare.gov says Part B covers one "Welcome to Medicare" preventive visit, once within the first 12 months you have Part B, describes it as a one-time preventive check-up, and says the visit isn't a comprehensive physical exam.
• CMS: Medicare & You 2027, the official U.S. government Medicare handbook (p. 32): The Medicare & You handbook says that for some preventive services you may have to pay a deductible, coinsurance or both, and that you may have to pay coinsurance and the Part B deductible if your provider does extra tests or services during your visit that aren't covered under a preventive service.
• Medicare.gov: Durable medical equipment (DME) coverage: Medicare.gov says Part B covers medically necessary DME if your doctor or other health care provider orders it for use in your home.
• Medicare.gov: Durable medical equipment (DME) coverage: Medicare.gov defines DME as equipment that is durable (can withstand repeated use), used for a medical reason, typically only useful to someone who is sick or injured, used in your home, and expected to last at least 3 years.
• Medicare.gov: Durable medical equipment (DME) coverage: Medicare.gov says Medicare-covered DME includes, but isn't limited to, canes, crutches, walkers, wheelchairs and scooters, hospital beds, and oxygen equipment and accessories.
• Medicare.gov: Durable medical equipment (DME) coverage: Medicare.gov says that, depending on the type of equipment, you may need to rent it, may need to buy it, or may be able to choose whether to rent or buy it.
• Medicare.gov: Durable medical equipment (DME) coverage: Medicare.gov says Medicare will only pay for DME items from suppliers enrolled in Medicare, and that it is important to ask suppliers if they participate in Medicare or will accept assignment before you get DME.
• Medicare.gov: Prescription drugs (outpatient): Medicare.gov says Part B covers a limited number of outpatient prescription drugs under certain conditions, and that usually Part B covers drugs you wouldn't typically give to yourself, like those you get at a doctor's office or in a hospital outpatient setting.
• Medicare.gov: Prescription drugs (outpatient): Medicare.gov says Medicare covers most injectable and infused drugs when a licensed medical provider gives them.
• Medicare.gov: Outpatient hospital services: Medicare.gov says that, generally, Part B doesn't cover prescription and over-the-counter drugs you get in an outpatient setting, sometimes called "self-administered drugs."
• Medicare.gov: Prescription drugs (outpatient): Medicare.gov says Medicare drug coverage (Part D) covers many drugs that Part B doesn't cover.
• Medicare.gov: Prescription drugs (outpatient): Medicare.gov says Part D generally covers all adult vaccines that the Advisory Committee on Immunization Practices (ACIP) recommends, including vaccines for RSV and shingles, among others.
• CMS: Medicare & You 2027, the official U.S. government Medicare handbook (p. 58): The Medicare & You handbook lists items and services Original Medicare doesn't cover, including non-medical long-term care, eye exams (for prescription eyeglasses and corrected contact lenses), cosmetic surgery, massage therapy, routine physical exams, hearing aids and exams for fitting them, and concierge care.
• CMS: Medicare & You 2027, the official U.S. government Medicare handbook (p. 58): The Medicare & You handbook says that in most cases Original Medicare doesn't cover dental services like routine cleanings, fillings, tooth extractions or items like dentures, but in some cases may pay for some dental services closely related to certain covered services.
• CMS: Medicare & You 2027, the official U.S. government Medicare handbook (p. 58): The Medicare & You handbook says Medicare and most health insurance don't pay for non-medical long-term care services, which include personal care assistance like help with everyday activities, including dressing, bathing and using the bathroom.
• CMS: Medicare & You 2027, the official U.S. government Medicare handbook (p. 58): The Medicare & You handbook says that if you need services Part A or Part B doesn't cover, you'll have to pay for them yourself unless you have other coverage or are in a Medicare Advantage Plan or Medicare Cost Plan that covers them, and that these plans may cover extra benefits like vision, hearing and dental services.
• Medicare.gov: Costs (Part B costs section): Medicare.gov says you'll pay the Part B premium each month, even if you don't get any Part B-covered services, and that the amount can change each year.
• CMS: Medicare & You 2027, the official U.S. government Medicare handbook (p. 23): The Medicare & You handbook says most people pay the standard Part B premium amount every month, and that Medicare uses the modified adjusted gross income reported on your IRS tax return from 2 years ago to determine if you'll pay an extra charge, called the Income-Related Monthly Adjustment Amount (IRMAA).
• CMS: Medicare & You 2027, the official U.S. government Medicare handbook (p. 24): The Medicare & You handbook says that if you get Social Security or Railroad Retirement Board benefits, your Part B premium will be deducted from your monthly benefit payment.
• Medicare.gov: Costs (Part B costs section): Medicare.gov says you pay the Part B deductible once each year, before Original Medicare starts to pay.
• CMS: Medicare & You 2027, the official U.S. government Medicare handbook (p. 32): The Medicare & You handbook says that after you meet the Part B deductible, Medicare pays its share and you typically pay 20% of the Medicare-approved amount, if the doctor or other health care provider accepts assignment.
• Medicare.gov: Outpatient hospital services: Medicare.gov says that in addition to the amount you pay the doctor, you'll also usually pay the hospital a copayment for each service you get in a hospital outpatient department, except for certain preventive services that don't have a copayment.
• CMS: Medicare & You 2027, the official U.S. government Medicare handbook (p. 32): The Medicare & You handbook says there's no yearly limit on what you pay out of pocket if you have Original Medicare.
• CMS: Medicare & You 2027, the official U.S. government Medicare handbook (p. 23): The Medicare & You handbook says to visit Medicare.gov for the latest Part B premium amount and income limits.
• Medicare.gov: Does your provider accept Medicare as full payment?: Medicare.gov says a provider who accepts assignment accepts the Medicare-approved amount as payment in full for a covered service, agrees to charge you only the Medicare deductible and coinsurance amount, and has to submit your claim directly to Medicare.
• Medicare.gov: Does your provider accept Medicare as full payment?: Medicare.gov says most doctors, providers and suppliers accept assignment, but to always check to make sure that yours do.
• Medicare.gov: Does your provider accept Medicare as full payment?: Medicare.gov says that if your provider doesn't accept assignment, you might have to pay the full amount at the time of service, and they can charge you more than the Medicare-approved amount; in many cases the charge can't be more than 15% above the Medicare-approved amount, which is called "the limiting charge."
• Medicare.gov: Does your provider accept Medicare as full payment?: Medicare.gov says Medicare won't pay for items or services you get from a provider that opts out of Medicare, except in emergencies.
• CMS: Medicare & You 2027, the official U.S. government Medicare handbook (p. 32): The Medicare & You handbook says you can find out if Medicare covers a service that isn't on its list on Medicare.gov or by calling 1-800-MEDICARE.
• CMS: Medicare & You 2027, the official U.S. government Medicare handbook (p. 32): The Medicare & You handbook says Medicare may cover some services and tests more often than described if your doctor needs them to diagnose or treat your condition.
• Medicare.gov: Doctor & other health care provider services: Medicare.gov says your doctor may recommend services that Medicare does not cover or offers too frequently, which could mean additional costs, suggests asking about the reasons for these recommendations and what Medicare will actually cover, and says the specific amounts you could owe depend on other insurance you may have, how much your doctor charges, whether your doctor accepts assignment, the type of facility and where you get your test, item or service.

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