What medicare part b covers is one of the most important things to understand before you enroll in Original Medicare. Part B is your medical insurance. It pays for doctor visits, outpatient procedures, preventive screenings, and much more.
However, it does not cover everything. Millions of beneficiaries are surprised each year when they discover gaps in their coverage. Knowing exactly what medicare part b covers helps you plan your healthcare budget and avoid unexpected bills. Whether you are turning 65, leaving employer coverage, or helping a parent navigate enrollment, a clear understanding of Part B benefits puts you in control of your medical care decisions.
What Medicare Part B Covers: Core Medical Services
Medicare Part B covers a wide range of outpatient medical services. Doctor office visits are the foundation. You are covered for specialist appointments, surgical consultations, and second opinions. Outpatient hospital services fall under Part B as well. For example, same-day surgery, emergency room visits, and observation stays are all included.
Part B also pays for diagnostic tests and lab work. Blood tests, X-rays, MRIs, and CT scans are covered when medically necessary. Durable medical equipment such as wheelchairs, walkers, oxygen tanks, and hospital beds qualifies too. Your doctor must order the equipment, and it must come from a Medicare-approved supplier. Mental health services receive coverage under Part B, including outpatient therapy, psychiatric evaluations, and substance abuse counseling. Ambulance services are covered when other transportation would endanger your health.
After you meet the annual deductible, Medicare typically pays 80% of the approved amount. You pay the remaining 20% as coinsurance. In 2026, the annual Part B deductible is $283. There is no out-of-pocket maximum in Original Medicare. As a result, many beneficiaries purchase a Medigap supplemental policy from carriers like Blue Cross, Aetna, Mutual of Omaha, or UnitedHealthcare to cover that 20% gap.
Preventive Services Covered at No Cost
One of the best aspects of what medicare part b covers is its preventive care benefit. Medicare covers dozens of preventive services with zero out-of-pocket cost. You pay no deductible and no coinsurance for these visits when you see a participating provider. The Annual Wellness Visit is free every year. New enrollees also qualify for a one-time “Welcome to Medicare” preventive visit within the first 12 months of enrollment.
Cancer screenings are covered at no cost. Mammograms, colonoscopies, prostate screenings, and lung cancer screenings all qualify. Colonoscopies are covered every 10 years for average-risk individuals and every 2 years for those at high risk. Cardiovascular screenings, diabetes tests, and depression screenings are included too. Vaccines are another major benefit. Flu shots, COVID-19 vaccines, Hepatitis B shots, and pneumococcal vaccines are all covered under Part B at no charge. In most cases, you simply show your Medicare card at a participating pharmacy or doctor’s office.
Part B Costs, Enrollment, and Late Penalties
Understanding what medicare part b covers also means understanding what it costs. The standard monthly premium in 2026 is $202.90. Higher-income beneficiaries pay more through an Income-Related Monthly Adjustment Amount, commonly called IRMAA. Premiums can reach several hundred dollars per month for individuals earning above $109,000 or couples above $218,000. You can check your specific premium bracket at Medicare.gov.
Your Initial Enrollment Period is a 7-month window. It starts 3 months before the month you turn 65 and ends 3 months after. Missing this window can trigger a late enrollment penalty. The penalty adds 10% to your monthly premium for every full 12-month period you delayed. This surcharge is permanent. It stays on your premium for as long as you have Part B. If you waited 24 months beyond your initial window, your premium increases by 20% for life. You can avoid the penalty if you had creditable employer coverage or qualify for a Special Enrollment Period through CMS.
A General Enrollment Period runs from January 1 through March 31 each year. Coverage begins the month after you enroll. Contact your local SHIP program for free counseling on enrollment timing and penalty avoidance. These state-funded counselors help thousands of beneficiaries make informed decisions every year.
What Part B Does Not Cover
Knowing what medicare part b covers is equally about knowing its limits. Part B does not pay for routine dental care, dentures, or dental implants. Routine vision exams, eyeglasses, and contact lenses are excluded. Hearing aids and their fitting exams are not covered either. Long-term nursing home care, cosmetic surgery, and routine foot care also fall outside Part B benefits.
Many beneficiaries close these gaps by enrolling in a Medicare Advantage plan from insurers like Humana, Cigna, or Aetna. These Part C plans often bundle dental, vision, and hearing benefits. Alternatively, standalone dental and vision policies are available. Check your options carefully at Medicare.gov’s plan finder.
Frequently Asked Questions
Does Medicare Part B cover prescription drugs?
No. Part B covers certain drugs administered by a doctor in a clinical setting, such as chemotherapy or injections. However, outpatient prescription medications require a separate Part D drug plan. You can enroll in a standalone Part D plan or get drug coverage through a Medicare Advantage plan.
Is there an out-of-pocket maximum with Part B?
Original Medicare Part B has no annual out-of-pocket cap. Your 20% coinsurance can add up quickly with major procedures. As a result, many beneficiaries purchase Medigap plans to limit their exposure. Medicare Advantage plans, by contrast, are required to include an annual out-of-pocket maximum.
What medicare part b covers for mental health — is therapy included?
Yes. Part B covers outpatient mental health services, including individual and group therapy. Psychiatric evaluations and medication management visits are included. In most cases, you pay 20% coinsurance after meeting your deductible. Telehealth mental health visits are also covered under current Medicare rules.
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Official Sources & Resources
For verified information on Medicare regulations and consumer protection:
- Medicare.gov (Official Site): medicare.gov
- CMS (Centers for Medicare & Medicaid Services): cms.gov
- NAIC (National Association of Insurance Commissioners): naic.org
- KFF Medicare Research: kff.org/medicare
- Social Security Administration: ssa.gov
Content last reviewed April 2026. If you notice any outdated information, please contact us.