What Does Medicare Part B Cover (2026)

What is Medicare Part B?

Medicare Part B is a type of medical insurance. It makes up half of Original Medicare. The other half is Medicare Part A.

Parts A and B together form Original Medicare, which is a federal health insurance program that helps pay for your healthcare. If you can get Medicare Part A, you can also choose to sign up for Part B.

An easy way to remember the difference is this:

• Part A helps pay for hospital stays.
• Part B helps pay for doctor visits and care you get outside the hospital.

According to the Centers for Medicare & Medicaid Services (CMS), Part B helps cover services that keep you healthy and treat problems before they become serious.

Who is Eligible for Medicare Part B?

You are eligible for Original Medicare, including Medicare Part B, if you meet one of three criteria:

• You’re aged 65 or older.
• You’re younger than 65 with eligible disabilities according to the Social Security Administration.
• You have Amyotrophic Lateral Sclerosis (ALS) or End-Stage Renal Disease (ESRD).

What Does Medicare Part B Cover?

Medicare Part B helps pay for two main types of care covered by Medicare: preventive services and medically necessary services.

• Preventive services help you avoid illness or catch health problems early.
• Medically necessary services are services or supplies your doctor decides are needed to diagnose, treat, or manage a medical condition. Medicare reviews these services using national coverage rules and accepted clinical guidelines.

Below is a clear breakdown of what this means in practice.

Preventive Services

Medicare Part B covers many preventive services at no cost when you see a provider who accepts Medicare assignment. These include:

• Annual Wellness Visit
• Welcome to Medicare Visit
• Vaccinations (flu, pneumococcal, Hepatitis B, COVID-19)
• Cancer screenings (mammogram, colonoscopy, prostate, lung cancer screening)
• Diabetes and cardiovascular screenings
• Depression and alcohol misuse screenings
• Bone density testing
• Obesity counseling and tobacco-use counseling

Medically Necessary Services

These services diagnose or treat health conditions and generally require you to pay the Part B deductible and 20% coinsurance (unless you have supplemental Medicare Advantage or Medicare Supplement coverage). Part B covers, but is not limited to:

• Doctor and specialist visits (orthopedics, cardiology, radiology, dermatology, and more)
• Mental health services (outpatient therapy, psychiatric evaluations, partial hospitalization)
• Lab work and diagnostic imaging, such as blood tests, X-rays, CT scans, and MRIs
• Outpatient surgeries and other outpatient hospital services
• Therapies, such as physical therapy, occupational therapy, and speech therapy when medically necessary
• Durable Medical Equipment (DME) like wheelchairs, walkers, CPAP machines, nebulizers, and blood pressure monitors
• Ambulance services, including emergency ground or air transport when medically necessary
• Some home health care services, such as part-time skilled nursing or therapy (when you meet Medicare’s homebound criteria)
• Clinical research and specific approved clinical trials

Outpatient Prescription Drugs Covered Under Part B

Medicare Part B includes limited prescription drug coverage, usually those given in a clinical setting, not prescriptions picked up at a pharmacy. This includes:

• Chemotherapy drugs
• Injectable or infused drugs given in a doctor’s office
• Dialysis-related drugs
• Immunosuppressive drugs after an organ transplant
• Certain oral cancer medications
• Drugs used with durable medical equipment (like nebulizers)
• Vaccines covered under Part B

Part B drugs vs. Part D drugs:

• Part B: drugs administered by a provider or used with medical equipment
• Part D: retail prescriptions you fill at the pharmacy

Emerging Areas of Coverage (Growing Under Part B)

Medicare Part B increasingly covers services delivered outside traditional offices, including:

• Telehealth and telemedicine visits
• Remote patient monitoring for chronic conditions
• More home-based services, including therapy and certain medical equipment used at home

These areas continue to expand due to legislative updates and temporary telehealth flexibilities extended through 2025.

What Part B Does Not Cover

Medicare Part B is designed to cover medically necessary and preventive services, but it does not cover everything. Some services are excluded because of Medicare law, not because your doctor or plan decides not to cover them. These exclusions apply to all Original Medicare beneficiaries unless you have other insurance that fills the gaps.

Why These Services Are Excluded

The reason many services aren’t covered is because the Social Security Act, which created Medicare, specifically defines what Medicare can and cannot pay for. These exclusions are written directly into the law, not left to doctors or Medicare to decide.

For example, the Social Security Act §1862(a)(12) states that Medicare will not pay for:

• “services in connection with the care, treatment, filling, removal, or replacement of teeth or structures directly supporting the teeth” (Social Security Act §1862(a)(12))
• routine eye exams
• routine hearing exams and hearing aids
• long-term custodial care

According to the Center for Medicare Advocacy, because these exclusions are set by law, Medicare cannot pay for these items under Part B unless they meet a narrow exception (such as dental work required for a covered medical procedure).

Services Part B Typically Does Not Cover

Part B doesn’t pay for the following routine or non-medically-necessary services:

• Routine dental care (cleanings, fillings, crowns, dentures)
• Routine vision exams and corrective glasses or contacts
• Hearing exams and hearing aids
• Long-term care or custodial care
• Cosmetic procedures (unless needed after an injury or illness)
• Most outpatient prescription drugs you pick up at a pharmacy
• Care received in a skilled nursing facility beyond what Medicare Part A covers
• Care received outside the United States (with limited exceptions)

Common Misconceptions

Many people assume Medicare covers age-related or routine care, but that’s not the case:

• “Does Medicare cover dental for seniors?”
  No. Routine dental care is not covered by Original Medicare (Parts A and B), and the law prohibits payment for most dental services. 
• “Does Medicare pay for eyeglasses?”
  No, unless they are prescribed after cataract surgery.
• “Are hearing aids covered?”
  No. Hearing aids and most hearing exams are not covered under Part B.

Understanding these exclusions helps you avoid surprise bills and plan for coverage gaps.

Agent tip:

Many people enroll in Part B and don’t realize it only covers about 80% of medically necessary services. If you want help avoiding high out-of-pocket costs, ask a licensed Medicare insurance agent to review your Medigap or Medicare Advantage options.

How to Get Coverage for Services Part B Doesn’t Cover

Even though Part B does not include these benefits, you do have options:

Medicare Advantage (Part C)

Most Medicare Advantage plans include:

• Dental benefits
• Vision exams and glasses
• Hearing tests and hearing aids
• Supplemental benefits such as OTC allowances, transportation, or meals

Medigap (Medicare Supplement Insurance)

Medigap policies do not add dental, vision, or hearing benefits, but they help pay:

• Part B 20% coinsurance
• Deductibles
• Copayments
• Excess charges

This reduces your out-of-pocket costs for services that Part B does cover.

Stand-Alone Dental, Vision, and Hearing Plans

You can buy private insurance for:

• Preventive and major dental work
• Eye exams and glasses
• Hearing evaluations and hearing aids

Need Help Deciding The Right Medicare Coverage For You?

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• Compare all major plans and carriers
• Local, licensed insurance agents with 25+ years of experience

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Bottom Line

Medicare Part B is a vital part of your healthcare coverage. It helps pay for doctor visits, preventive care, outpatient services, and medical equipment, giving you access to the care you need to stay healthy and independent. 

Have questions about Medicare Part B or need help choosing the right plan? A local licensed Connie Health Medicare insurance agent is here to help. Call (623) 223-8884 today to compare plans.

Need Help Deciding The Right Medicare Coverage For You?

• Free, unbiased service
• Compare all major plans and carriers
• Local, licensed insurance agents with 25+ years of experience

Call Now Compare Plans

Frequently Asked Questions

What's the difference between Medicare Part A and Part B?

Part A is your hospital insurance. It covers inpatient stays, skilled nursing care, hospice, and some home health services. Part B is your medical insurance. It covers doctor visits, outpatient care, preventative services, and medical equipment. Most people don’t pay a premium for Part A, but nearly everyone pays a monthly premium for Part B.

Can I have Medicare Part B and employer insurance at the same time?

Yes, you can. If you’re still working and have insurance through your employer (or your spouse’s employer), you may be able to delay Part B without penalty. It depends on the company’s size. If the employer has 20 or more employees, you can usually delay Part B. If it’s a smaller employer, you may need to enroll in Part B when you turn 65 to avoid gaps in coverage.

Does Medicare Part B cover dental, vision, or hearing services?

No. Medicare Part B does not cover routine dental care, vision exams or glasses, or hearing tests and hearing aids. It only covers these services in limited medical situations, such as eye care after cataract surgery. For routine benefits, you may need a Medicare Advantage plan or a separate dental, vision, and hearing policy.                                                                                 

Does Medicare Part B cover prescription drugs?

Part B covers a very limited number of outpatient prescription drugs, mainly vaccines, certain injectable medications given in a doctor’s office, and some drugs used with durable medical equipment (like nebulizers). For most prescription drugs, you’ll need to enroll in a separate Medicare Part D plan or a Medicare Advantage plan that includes drug coverage.

How do I know if my doctor accepts Medicare Part B?

Most doctors accept Original Medicare, but it’s always smart to check before your appointment. You can also call the doctor’s office directly and ask if they accept Medicare assignment, which means they agree to Medicare’s approved payment amount.