Medicare Part B of Original Medicare and Medicare Advantage (Part C) cover the costs of doctor visits. However, there may be extra costs.

Medicare is a federally funded insurance plan consisting of various parts, mainly including Part A, Part B, Part C, and Part D. Each part covers different medical expenses, such as doctor visits.

It primarily covers people who are over 65 years old. However, younger people with end stage kidney disease, amyotrophic lateral sclerosis, or those with certain disabilities are also eligible.

This article explains which parts of Medicare cover doctor visits, what types of appointments they cover, and how much the plans cost.

Glossary of Medicare terms

We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:

  • Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
  • Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
  • Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
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Original Medicare comprises Part A, which covers hospital care, and Part B, which covers many medical services, including doctor visits.

Medicare Part B

Medicare Part B covers two types of services: medically necessary and preventive.

It covers services, such as:

  • doctor’s visits and services
  • outpatient care
  • other services that Part A does not cover, such as:
    • ambulance services
    • durable medical equipment
    • clinical research
    • mental health services

Preventive care helps prevent illnesses or stop early stage conditions from progressing.

It also covers preventive services, such as:

Medically necessary services are those that a healthcare professional uses to diagnose someone’s medical condition according to their symptoms and to provide them with treatment.

Some preventive services have no associated costs when a healthcare professional agrees to accept the assignment. This means they have a contract to bill Medicare directly.

Individuals can check whether their plan covers the test or service they need using Medicare’s online tool.

Learn more about Medicare Part B.

Medicare Part C (Medicare Advantage)

Medicare Part C, which is known as Medicare Advantage, is an all-in-one alternative to Original Medicare that private insurance companies administer. These plans must provide the same coverage level as Original Medicare, including coverage for doctor visits.

Medicare sends payment directly to the doctor, although individuals may need to pay coinsurance and meet a deductible. These costs vary by plan.

Learn more about Medicare Advantage plans.

Medicare typically does not cover certain services and doctor’s appointments, including:

  • podiatry, which can involve callous removal, corn removal, or toenail trimming
  • optometry, including regular eye health checkups and getting a new prescription — Medicare Advantage plans may offer this as an added service
  • naturopathic medicine, including acupuncture, unless it is to treat lower back pain
  • dental services, although Medicare Advantage may cover some dentistry
  • most chiropractic services, unless they are for spinal subluxation, or misaligned spinal disk

Part B may limit coverage to a set number of services in a year or lifetime. For example, someone can have blood tests to screen for heart disease once every 5 years.

Anyone who has had Medicare Part B for longer than 12 months is entitled to a free annual wellness visit that is not subject to a deductible.

Beyond that, Medicare Part B covers 80% of the Medicare-approved cost of medically necessary doctor visits. The individual must pay 20% to the doctor or service provider as coinsurance.

The Part B deductible also applies, which is $240 in 2024. The deductible is the amount of money that a person pays out of pocket before the insurance begins to cover the costs.

A person also needs to pay a premium to keep the policy. The standard monthly premium in 2024 is $174.70.

If a person did not sign up when they were eligible at the age of 65 years, they might also need to pay a late enrollment penalty. This penalty can increase the premiums by 10% for each year that someone qualified for Medicare but did not enroll.

The costs relating to Medicare Advantage Plans vary depending on several factors, including:

  • whether the plan has a premium
  • whether the plan pays the Medicare Part B premium
  • the yearly deductible, copayment, or coinsurance
  • the annual limit on out-of-pocket expenses
  • the type of healthcare services a person needs

Medicare resources

For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.

Medicare Part B and Medicare Advantage plans cover visits to the doctor. These plans generally pay for medically necessary services and some preventive care, such as screenings and vaccines.

Medicare does not limit the number of times a person can consult their doctor, but it may limit how often they can have a particular test and access other services.

Individuals can contact Medicare directly at 800-MEDICARE (800-633-4227) to discuss physician coverage in further detail.