Part B medical insurance is intended to cover basic medical services provided by doctors, clinics, and laboratories. But the lists of services specifically covered and not covered are long, and do not always make a lot of common sense.
Making the effort to learn what is and is not covered can be important, because you can get the most benefits by fitting your medical treatments into the covered categories whenever possible. (For an explanation of how much of your covered costs Part B pays, see our article on what you pay for Medicare Part B services.)
Here are the services that Medicare Part B pays for.
Part B medical insurance covers medically necessary doctors' services, including surgery, whether the services are provided at the hospital, at a doctor's office, or—if you can find such a doctor—at home.
Part B also covers outpatient medical services provided by hospital and doctor's office staff who assist in providing care, such as nurses, nurse practitioners, surgical assistants, and laboratory or X-ray technicians.
Medicare medical insurance covers outpatient hospital treatment, such as emergency room or clinic charges, X-rays, injections that are not self-administered, and laboratory work and diagnostic tests. Lab work and tests can be done at the hospital lab or at an independent laboratory facility, as long as that lab is approved by Medicare.
Beware: Medicare pays only a limited amount of outpatient hospital and clinic bills. Unlike most other kinds of services, Medicare places no limits on how much the hospital or clinic can charge for outpatient services over and above what Medicare pays.
Part B medical insurance will cover the cost of transporting a patient by ambulance, if transport by any other means wouldn't be medically advisable. This includes not only emergencies, but also nonemergency trips following discharge from a hospital—for example, to the patient's home or to a nursing facility.
Transporting residents of nursing facilities to see their doctors may also be covered. But Medicare doesn't cover ambulance transport for regular visits from a person's home to a doctor's office, if the trip was arranged simply because the person needed some assistance.
If your doctor prescribes an ambulance for you for a trip from home to the doctor's office, Medicare may cover it but it isn't required to. Medicare will cover the ambulance trip only if the doctor's communication with Medicare convinces Medicare that the ambulance was medically necessary.
If Medicare covers an ambulance trip, the ambulance company must accept the Medicare-approved amount as full payment for its services. Medicare will pay 80% of that amount. You, or your medigap insurer or Medicare Advantage plan, are responsible for paying the remaining 20%. The ambulance company may not bill you for any amount over that 20%.
Drugs or other medicines administered to you at the hospital or doctor's office are covered by medical insurance. But Medicare Part B does not cover most drugs you take by yourself at home, including self-administered injections, even if your doctor prescribes them.
Exceptions to this rule are self-administered oral cancer medication, antigens, and immunosuppressive drugs, which are covered by Medicare. Also, flu, COVID-19, and pneumonia vaccines are covered by Medicare, even though other vaccinations are not. The flu and COVID-19 shots you can obtain on your own, but the pneumonia vaccination requires a doctor's prescription.
The following types of equipment and supplies are covered by Medicare Part B if prescribed by a doctor:
To learn more about the many types of medical equipment and supplies Medicare Part B covers, and how different equipment may be rented or purchased, see Medicare's publication Medicare Coverage of Durable Medical Equipment and Other Devices.
To find a Medicare-certified supplier of medical equipment near you, go to the Medicare website home page at www.medicare.gov and click on "Providers & services" and then "Find medical equipment and suppliers."
Some types of surgery on the jaw or facial bones, or on the related nerves or blood vessels, can be covered by Part B medical insurance. However, surgery on teeth or gums, even when related to an injury or a disease that did not originate with the teeth, is usually considered to be dental work, and so is not covered by Medicare.
Although normal dental care isn't covered by Medicare, damage to teeth or gums connected to an injury or disease is a medical as much as a dental problem. Medicare does have one route to coverage: If the work is done by a dentist or oral surgeon, Medicare will cover it if physicians also regularly provide the same kind of care and if Medicare would cover the care if a doctor had provided it. This is usually determined by whether the treatment involves just the teeth and gums (not covered) or also the bones, inside mouth, blood vessels, or tongue (covered).
Part B of Medicare will cover some of the cost of outpatient physical, occupational, and speech therapy—if it's prescribed and regularly reviewed by a doctor and provided by a Medicare-approved facility or therapist.
For therapy received at an office or rehab facility, rather than a hospital's outpatient department, Medicare will pay 80% of the Medicare-approved amount. You or your supplemental medigap insurance are responsible for the other 20%. (Or, if you have a Medicare Advantage plan, you may have to pay a small copay instead.)
There's no limit or "therapy cap" to the amount of physical therapy (PT), occupational therapy (OT), or speech-language pathology (SLP) services that you can receive. But, after a certain amount of spending on these services, your doctor must submit more documentation to Medicare to show that continued therapy is medically necessary. In 2023, that threshold amount is $2,230 for OT and $2,230 for PT/SLP combined. This amount increases slightly each year.
The same home health care coverage is available under Part B medical insurance as is provided by Part A hospital insurance. (See our article on Medicare coverage of home health care.)
There's no limit on the number of home health care visits that are covered, and you aren't responsible for your Part B deductible for home health care. But Medicare only covers skilled nursing care or therapy while you're confined to your home, and such care must be ordered by your doctor and provided by a Medicare-approved home health care agency.
Part B medical insurance, like Part A coverage, will pay 100% of the approved charges of a participating home health care agency. If you have both Part A and Part B, Part A will cover your home health care following a hospital stay of at least three days; otherwise, Part B will cover it.
Part B may cover some care by a Medicare-certified chiropractor. Generally, Medicare will cover a limited number of visits to a chiropractor for manipulation of neck or back vertebrae that are out of place. Medicare won't, however, cover general health maintenance visits to a chiropractor, nor will it usually cover therapeutic manipulation other than of the vertebrae. And Medicare generally will not cover X-rays or other diagnostic tests done by the chiropractor. Instead, your physician normally must order these tests.
If you go to a chiropractor and hope to have Medicare pay its share of the bill, have the chiropractor's office check with Medicare ahead of time about the treatment being proposed. Even if Medicare initially agrees to covers the treatment, it may not do so indefinitely. So, if you continue with the treatments, have the chiropractor's office regularly check with Medicare to find out how long it will keep paying.
Medicare covers the following examinations to screen for a number of serious illnesses:
Part B covers a yearly mammogram, even if you haven't met your annual deductible. The mammogram must be performed by your doctor or by a facility certified for mammography by Medicare.
Medicare covers podiatrist services only when they consist of treatment for injuries or diseases of the foot. Medicare doesn't cover routine foot care or treatment of corns or calluses.
Medicare doesn't cover routine eye examinations, glasses, or contact lenses. The only exception is for people who have undergone cataract or other eye surgery. For them, Medicare covers glasses, contact lenses, or intraocular lenses, as well as the cost of an examination by a Medicare-certified optometrist.
When a doctor or hospital prescribes it in conjunction with medical treatment, Medicare Part B can cover counseling by a clinical psychologist or clinical social worker. The practitioner must be Medicare-approved. If your doctor suggests a clinical psychologist or social worker to help in your recovery from surgery, injury, or illness, contact the practitioner in advance to find out whether the services will be approved by Medicare.
Medicare Part B also covers one depression screening per yeat and a yearly mental health wellness visit.
Medicare Part B can cover mental health care in the form of day treatment—also called partial hospitalization—at a hospital outpatient department or community mental health center. The facility must be Medicare-approved and the particular day program certified for Part B coverage by Medicare.
Until recently, Medicare did not cover various kinds of physical, speech, and occupational therapy, or psychotherapy and other mental health services for people who had been diagnosed with Alzheimer's disease. Medicare's reasoning was that patients with Alzheimer's were incapable of medically improving, and that the treatment was therefore not "medically necessary."
Medicare has now reversed its stance and a patient can no longer be denied Medicare coverage for physician-prescribed therapies or treatments solely because the patient has been diagnosed with Alzheimer's.
Medicare will cover various scientifically proven weight-loss therapies and treatments. These range from stomach surgeries to diet programs to psychological and behavior-modification counseling. Not all treatments are covered, and not all patients will be eligible for all covered treatments. But if you are undergoing care from a physician for obesity, the physician can recommend a specific treatment for you and submit it to Medicare for coverage approval.
To learn what services Medicare Part B won't cover, see our article on services not covered by Medicare Part B.