Does Medicare Cover All of Your Doctor Visits?
Navigate Medicare's coverage for doctor visits. Understand what's included, your costs, and how different plans impact your care.
Medicare is a federal health insurance program that helps eligible individuals with healthcare costs. It covers millions of Americans, mainly those 65 or older, and some younger people with certain disabilities or medical conditions. Medicare generally helps with doctor visit expenses.
Core Medicare Coverage for Doctor Visits
Original Medicare Part B is the primary component covering doctor visits. Part B, or Medical Insurance, helps pay for medically necessary services and supplies, including physician services, outpatient care, and preventive services. This includes visits with medical doctors, doctors of osteopathic medicine, nurse practitioners, and physician assistants.
A service is “medically necessary” if it meets accepted medical standards and is needed to diagnose or treat an illness, injury, condition, or its symptoms. Part B covers a wide range of doctor visits, from routine check-ups to specialist consultations, ensuring care for diagnosed conditions or for diagnosis.
Understanding Your Costs for Doctor Visits
Original Medicare Part B beneficiaries have out-of-pocket costs for doctor visits. After meeting an annual deductible, Part B typically covers 80% of the Medicare-approved amount for most physician services. The 2025 Part B deductible is $257.
Once the deductible is met, you generally pay 20% as coinsurance. This applies to many outpatient services and medical equipment covered by Part B. When a doctor accepts Medicare assignment, they agree to the Medicare-approved amount as full payment and only bill you for the deductible and coinsurance. If a provider does not accept assignment, they may charge up to 15% more than the Medicare-approved amount (an “excess charge”) and may require upfront payment.
Specific Types of Doctor Visits and Services
Medicare Part B covers various doctor visits and services, including preventive and diagnostic care. Preventive services help prevent illness or detect health problems early, such as annual wellness visits, screenings for diabetes or cardiovascular disease, and vaccinations. Many preventive services are covered at no cost if your provider accepts assignment, even before your deductible is met.
Diagnostic services are covered when a doctor orders them to diagnose or treat a medical problem. This includes visits for specific symptoms, follow-up appointments, and clinical diagnostic laboratory tests like blood work or urinalysis, for which you typically pay nothing.
However, Original Medicare generally does not cover routine dental care, eye exams solely for glasses prescriptions, or hearing aids. While some emergency dental services might be covered if treated in a hospital, most routine vision, dental, and hearing needs are not included.
How Medicare Advantage Plans Affect Doctor Visit Coverage
Medicare Advantage Plans (Part C) offer an alternative way to receive Medicare benefits, including doctor visit coverage. These plans are administered by private insurance companies approved by Medicare and must cover at least all services Original Medicare Part A and Part B cover, including medically necessary doctor visits and preventive care.
While Medicare Advantage plans provide the same core coverage, their cost-sharing and rules for doctor visits can differ from Original Medicare. You might encounter different copayments for doctor visits, and plans often have specific provider networks, such as Health Maintenance Organizations (HMOs) or Preferred Provider Organizations (PPOs). Some Medicare Advantage plans may also require referrals from a primary care physician to see specialists, which is typically not a requirement with Original Medicare. These variations in cost and access mean it is important to understand the specific rules of any Medicare Advantage plan you consider.