Medicare Part B covers a wide range of doctor’s visits, including medically necessary appointments and preventive care. However, what isn’t covered may surprise you, and those surprises can come with a hefty bill.
Here’s what you need to know about coverage and costs — before you book your next doctor’s visit.
Medicare Part B covers 80 percent of the Medicare-approved cost of medically necessary doctor’s visits.
This includes outpatient services you receive in your doctor’s office or in a clinic. It also includes some inpatient services in a hospital. In order to get coverage, your doctor or medical supplier must be Medicare-approved and accept assignment.
Medicare Part B also covers 80 percent of the Medicare-approved cost of preventive services you receive from your doctor or other medical provider. This includes wellness appointments, such as an annual or 6-month checkup.
Your annual deductible will need to be met before Medicare covers the full 80 percent of medically necessary doctor’s visits. In 2020, the deductible for Part B is $198. This represents an increase of $13 from the annual deductible of $185 in 2019.
Preventive services will be paid in full by Medicare, even if your deductible hasn’t been met.
Medicare will cover doctor’s visits if your doctor is a medical doctor (MD) or a doctor of osteopathic medicine (DO). In most cases, they’ll also cover medically necessary or preventive care provided by:
- clinical psychologists
- clinical social workers
- occupational therapists
- speech language pathologists
- nurse practitioners
- clinical nurse specialists
- physician assistants
- physical therapists
Medicare Part B covers doctor’s visits. So do Medicare Advantage plans, also known as Medicare Part C.
Medigap supplemental insurance covers some, but not all, doctor’s visits that aren’t covered by Part B or Part C. For example, Medigap will cover some costs associated with a chiropractor or podiatrist, but it won’t cover acupuncture or dental appointments.
Medicare doesn’t cover certain medical services that you may consider preventive or medically necessary. However, there are sometimes exceptions to this rule.
For questions about your Medicare coverage, contact Medicare’s customer service line at 800-633-4227, or visit the State health insurance assistance program (SHIP) website or call them at 800-677-1116.
If your doctor lets Medicare know that a treatment is medically necessary, it may be covered partially or fully. In some instances, you may incur additional, out-of-pocket medical costs. Always check before you assume that Medicare will or won’t pay.
Other circumstances under which Medicare will not pay for a medical appointment include the following:
- Medicare won’t cover appointments with a podiatrist for routine services such as corn or callous removal or toenail trimming.
- Medicare sometimes covers services provided by an optometrist. If you have diabetes, glaucoma, or another medical condition that requires annual eye exams, Medicare will typically cover those appointments. Medicare doesn’t cover an optometrist visit for a diagnostic eyeglass prescription change.
- Original Medicare (parts A and B) doesn’t cover dental services, though some Medicare Advantage plans do. If you have a dental emergency treated in a hospital, Part A may cover some of those costs.
- Medicare doesn’t cover naturopathic medicine, such as acupuncture. Some Medicare Advantage plans offer acupuncture coverage.
- Medicare will only cover chiropractic services, such as spinal manipulation, for a condition known as spinal subluxation. In order to ensure coverage, you’ll need an official diagnosis from a licensed and qualified chiropractor. Medicare Advantage plans may cover additional chiropractic services.
There may be other medical visits and services that Medicare won’t cover. When in doubt, always check your policy or enrollment information.
Important Medicare deadlines
- Initial enrollment: 3 months before and after your 65th birthday. You should enroll for Medicare during this 7-month period. If you’re employed, you can sign up for Medicare within an 8-month period after retiring or leaving your company’s group health insurance plan and still avoid penalties. Under federal law, you can also enroll for a Medigap plan anytime during the 6-month period beginning with your 65th birthday.
- General enrollment: January 1 – March 31. If you miss the initial enrollment period, you can still sign up for Medicare anytime during this period. However, you may be charged an ongoing late-enrollment penalty when your benefits go into effect. During this period, you can also change or drop your Medicare Advantage plan and opt for original Medicare instead. You can also get a Medigap plan during general enrollment.
- Annual open enrollment: October 15 – December 7. You may make changes to your existing plan each year during this time.
- Enrollment for Medicare additions: April 1 – June 30. You can add Medicare Part D or a Medicare Advantage plan to your current Medicare coverage.
Medicare Part B covers 80 percent of the cost of doctor’s visits for preventive care and medically necessary services.
Not all types of doctors are covered. In order to ensure coverage, your doctor must be a Medicare-approved provider. Check your individual plan or call Medicare’s customer service line at 800-633-4227 if you need specific coverage information.