What Does Medicare Part B Cover? 7 Critical Facts and Gaps
Most people assume Part B covers more than it does. This guide shows you exactly what it covers, what it costs, and where the gaps are.
Find a Medicare Insurance Broker Near You →Last updated: May 2026
What Does Medicare Part B Cover?
Medicare Part B is your medical insurance. It is the piece of Original Medicare that covers doctor visits, outpatient care, and most of the healthcare you use day to day. But what does Medicare Part B cover, exactly? And more importantly, what does it leave to you? Fidelity estimates that a 65-year-old couple will spend $345,000 on healthcare costs in retirement. Part B is the piece of that equation most people assume covers more than it does.
Part B is one of four parts of Medicare. Part A covers hospital stays and inpatient care. Part B covers everything else on the outpatient side: your doctors, your screenings, your equipment, and most of your ongoing medical care. Together, Part A and Part B make up Original Medicare. For a full overview of how all four parts work together, see our guide to Medicare Parts Explained.
This guide breaks down the seven service categories Part B covers, what you will actually pay, and where the coverage gaps are that catch most people off guard.
What Does Medicare Part B Cover? At a Glance
- Doctor visits and outpatient medical care
- Preventive care and screenings (usually free)
- Outpatient mental health services
- Durable medical equipment (wheelchairs, walkers, CPAP)
- Home health care (skilled nursing and therapy only)
- Ambulance services (when medically necessary)
- Part B drugs (administered in a clinical setting)
The 7 Service Categories Medicare Part B Covers
When families ask what does Medicare Part B cover, the answer falls into seven categories. The full list comes from Medicare.gov’s Part B coverage page.
1. Doctor visits and outpatient medical care. Part B covers medically necessary services from physicians, surgeons, and specialists. That includes office visits, consultations, outpatient surgery, diagnostic lab tests, and X-rays. If you see a cardiologist, get a CT scan at an outpatient imaging center, or have a minor procedure done without being admitted to the hospital, Part B is what pays 80% of the cost after your deductible. One thing to keep straight: outpatient care is Part B territory. If you are actually admitted as a hospital inpatient, that shifts to Part A.
2. Preventive care and screenings. Part B covers a wide range of preventive services at no cost to you, as long as your provider accepts Medicare. This includes your annual wellness visit, flu shots, COVID-19 vaccines, pneumococcal vaccines, mammograms, colonoscopies, cardiovascular screenings, bone density tests, diabetes screenings, and depression screening. You pay nothing for most preventive services. One exception: if your annual wellness visit turns into a problem-focused appointment because you bring up a specific symptom, Part B will bill separately for the treatment portion of that visit.
3. Outpatient mental health services. Part B covers visits with psychiatrists, psychologists, and licensed clinical social workers for outpatient mental health care. It also covers partial hospitalization programs for mental health treatment, which provide structured daytime care without a full inpatient stay. You typically owe 20% coinsurance after your deductible, the same as most other Part B services. Inpatient psychiatric care is covered under Part A, not Part B.
4. Durable medical equipment (DME). If your doctor prescribes medically necessary equipment for home use, Part B covers it through an approved Medicare supplier. This includes wheelchairs, walkers, canes, hospital beds, oxygen equipment, CPAP and BiPAP machines for sleep apnea, and blood sugar monitors for people with diabetes. You generally owe 20% of the Medicare-approved amount for DME. One requirement: the equipment must come from a Medicare-approved supplier, or Part B will not pay.
5. Home health care (skilled only). Part B covers skilled home health services when a doctor orders them and you qualify as homebound. Covered services include skilled nursing visits, physical therapy, occupational therapy, and speech-language pathology. The key word is skilled. Part B covers care that requires medical training to perform. It does not cover custodial home care, which is help with bathing, dressing, eating, or other activities of daily living unless skilled care is also happening at the same time. This distinction is one of the most common points of confusion families run into, and we cover it in depth in our upcoming guide on whether Medicare covers home health care.
6. Ambulance services. Part B covers emergency ambulance transport when it is medically necessary to get you to the nearest appropriate facility safely. Some non-emergency ambulance transport is also covered when traveling by other means would put your health at risk. You owe 20% coinsurance after your deductible. Part B will not pay for ambulance transport if you could safely travel by car or another method.
7. Part B drugs. Part B covers a specific category of prescription drugs: ones that are administered in a clinical setting by a healthcare provider, rather than ones you fill at a pharmacy and take at home. Examples include chemotherapy infusions, immunosuppressive drugs for organ transplant patients, certain injections given in a doctor’s office, and anti-nausea drugs administered alongside chemotherapy. This category often surprises people because they assume all prescription coverage falls under Part D. If your doctor gives you a drug in the office or at an infusion center, it is likely Part B. If you pick it up at a pharmacy counter, it is Part D.
What Medicare Part B Actually Costs You
Knowing what does Medicare Part B cover is only half the picture. The other half is what you will actually pay. The cost structure has four pieces, and missing any one of them leads to real surprises.
| Cost | 2026 Amount |
|---|---|
| Monthly premium | $202.90 (standard rate) |
| Annual deductible | $283 |
| Coinsurance (most services) | 20% of Medicare-approved amount |
| Preventive services | $0 (free, when using an accepting provider) |
| Clinical lab tests | $0 (fully covered) |
Source: Medicare.gov cost page. 2026 figures.
The monthly premium and annual deductible are straightforward. The 20% coinsurance is where things get complicated. After you meet your $283 deductible, Medicare pays 80% of the Medicare-approved amount for most services. You pay the other 20%. That sounds manageable for a routine doctor visit. It gets less manageable for a major surgery or a long course of outpatient treatment.
What Medicare Part B Does Not Cover
Understanding what does Medicare Part B cover also means knowing where it stops. These are the gaps that catch the most people off guard.
Routine dental care. Original Medicare does not cover cleanings, fillings, dentures, or most extractions. There are narrow exceptions when dental work is directly tied to a covered medical procedure, such as dental clearance required before heart valve surgery. But for regular dental care, you are on your own unless you have a Medicare Advantage plan that includes dental coverage.
Routine vision. Part B does not cover eye exams for glasses or contacts. It does cover cataract surgery and, in that specific case, one pair of standard frames or contact lenses afterward. For general vision care, you need either a Medicare Advantage plan with vision benefits or a separate vision policy.
Hearing aids. This is one of the most common surprises. Original Medicare does not cover hearing aids or the routine hearing exams to fit them. For many people, hearing loss is the first significant healthcare need they run into after turning 65 and enrolling in Medicare. Some Medicare Advantage plans include hearing benefits, which is one reason people compare Advantage and Original Medicare carefully before enrolling.
Prescription drugs from a pharmacy. If you pick up a prescription at the pharmacy counter, that is Part D territory, not Part B. Part B covers drugs administered in a clinical setting, as described in service category 7 above. For the prescriptions you take at home, you need a separate Part D drug plan or a Medicare Advantage plan that includes Part D coverage.
Custodial care and long-term care. Part B will not pay for help with daily activities like bathing, dressing, eating, or managing medications when that is the primary need. This category of care, often called custodial or personal care, is not covered by Original Medicare at all. Long-term care in a nursing home or assisted living facility falls almost entirely outside what Medicare covers. Families planning for this gap usually look at long-term care insurance, Medicaid planning, or private savings.
Most care outside the United States. Original Medicare generally does not pay for care you receive in another country. There are limited exceptions near US borders and in very specific circumstances, but for most travel, you need a supplemental travel health plan or a Medigap policy that includes foreign travel emergency coverage.
What does Medicare Part B cover, and is it enough on its own? For most people, it covers more than they expect — but the 20% coinsurance and the gaps add up fast enough that the answer is almost always “it depends.” A licensed broker can run that comparison with you at no cost, and most take less than 30 minutes.
Frequently Asked Questions
Is Medicare Part B free at age 65?
For most people, no. The standard 2026 Part B premium is $202.90 per month. If you receive Social Security benefits, this amount is automatically deducted from your monthly check. If you are not yet collecting Social Security, you are billed directly by Medicare. Some people qualify for help paying the premium through state Medicare Savings Programs or Medicaid, depending on income and assets. It is worth checking with your state’s Medicaid office if cost is a concern. Part A, which covers hospital care, is generally premium-free if you or your spouse worked and paid Medicare taxes for at least 10 years. Part B always comes with a monthly cost.
Does Medicare Part B cover hearing aids?
No. Original Medicare does not cover hearing aids or the hearing exams needed to fit them. This surprises a lot of people because hearing loss is extremely common after age 65 and the average price paid for hearing aids is $2,694 per pair, according to a HearingTracker survey of more than 1,100 buyers, with costs varying significantly depending on where you purchase and what technology level you choose. If hearing coverage matters to you, some Medicare Advantage plans (Part C) include hearing benefits that Original Medicare does not. A licensed health insurance broker can help you compare what is available in your area at no cost to you.
Does Medicare Part B cover prescription drugs I pick up at a pharmacy?
No. Drugs you fill at a pharmacy and take at home are covered under Medicare Part D, which is a separate prescription drug plan. Part B covers a different category: drugs administered in a clinical setting by a healthcare provider, such as chemotherapy infusions or certain injections given in a doctor’s office. When you enroll in Medicare, you typically add a Part D drug plan alongside your Part A and Part B coverage, or choose a Medicare Advantage plan that bundles all three together.
Does Medicare Part B cover physical therapy?
Yes. Part B covers outpatient physical therapy, occupational therapy, and speech-language pathology when ordered by a doctor and provided by a Medicare-approved supplier. There is no annual cap on covered therapy services as long as they are medically necessary. You will typically owe 20% coinsurance after your Part B deductible. If therapy happens at home as part of a physician-ordered home health plan, it is also covered under Part B’s home health benefit.
What is the difference between Medicare Part A and Part B?
People often search “what does Medicare Part B cover” when they really mean to compare it to Part A. Part A is your hospital insurance and Part B is your medical insurance. Part A covers inpatient hospital stays, skilled nursing facility care (short-term, following a qualifying hospital stay), and some home health care. Part B covers what this article describes: doctor visits, outpatient care, preventive services, durable medical equipment, and services you receive outside a hospital. Together, Part A and Part B make up Original Medicare. For a complete breakdown of all four parts, see our Medicare Parts Explained guide.
📋 Free Download: Medicare in Plain English
New to Medicare? Get our plain-language guide to Parts A, B, C, and D delivered straight to your inbox.
Continue Reading: Medicare and Health Insurance Guides
Content on SetToRetire.com is researched and drafted with AI assistance, then reviewed and edited for accuracy by the editorial team at Senior Media Group LLC. It is provided for general informational purposes only and does not constitute medical, legal, or financial advice. Medicare coverage rules, premiums, and deductibles change annually. Consult a licensed Medicare counselor, insurance broker, or your State Health Insurance Assistance Program (SHIP) for advice specific to your situation. For more on how we create content, see our Editorial Process.
