Does Medicare cover doctor visits?

Medicare Part B covers doctor visits, but coverage of some provider services may be limited or excluded

By Lindsay Malzone | Updated on Apr. 7, 2024 Medically reviewed by Scott Dershowitz, LMSW, CMC

Most healthcare providers prefer to see a patient at least once a year to discuss changes in lifestyle, health risks, and vitals. They use this information to formulate a plan to help patients stay healthy. As we age, the number of doctor visits can increase. People 65 and older visit the doctor nearly four times more often than 18- to 44-year-olds, according to the Centers for Disease Control and Prevention. More doctor visits can result in more copays. It’s important for Medicare beneficiaries to know which types of doctor visits are covered.

Does Medicare cover doctor visits?

Medicare Part B covers outpatient doctor visits.

You can get Part B coverage through Original Medicare (does not include prescription drug coverage) or Medicare Part C (also called Medicare Advantage).

When you visit a healthcare provider with Original Medicare, you‘re responsible for the annual Part B deductible. Once that is met, Medicare pays 80% of the Medicare-approved amount. This leaves you responsible for a 20% coinsurance and up to a 15% excess charge if your healthcare provider does not accept Medicare assignment.

When you visit a healthcare provider with Medicare Advantage, you can expect a fixed copay in most cases. These plans have little to no monthly cost, and they can include your drug coverage and additional benefits that aren’t covered by Original Medicare.

You can find health plans in your area using the Medicare Plan Finder to review the office visit costs on Medicare Advantage plans in your area.

Types of doctor visits that are not covered

Original Medicare will only cover doctors’ office visits that are considered medically necessary. While most of your healthcare providers and visits will fall under this category, there are a few things that are not.

Dentist appointments are not covered.
Optometrist appointments are only covered if you have a medical condition that deems the services medically necessary. Routine checkups, exams, and eyewear are not covered.
Audiologists are not covered for routine services such as exams and hearing aids.
Cosmetic procedures are not covered by Medicare.
Podiatric care is only covered by Medicare when medically necessary. Podiatrist appointments for routine services, such as toenail trimming and callous or corn removal, are generally not covered.
Chiropractic services are only covered for treating vertebral subluxation of the spine.
Medicare covers preventive care on fixed schedules. Preventive services outside of the Medicare schedule are not covered.

Note: Items that are not covered by Medicare may be covered if there is a medical condition that the procedure or appointment becomes Medically necessary.

Medicare Advantage plans may offer coverage for dental, vision, hearing, chiropractic care, and more. Each plan covers different services, so check with your plan’s benefit schedule to ensure the coverage you are looking for is included.

Does Medicare cover virtual doctor visits?

Some virtual doctor visits (or telehealth visits) also may be covered under Medicare Part B. The coverage is the same as it is for a regular on-site doctor‘s appointment. Since Medicare covers virtual visits, they‘ll also be covered under Medicare Supplement and Medicare Advantage plans.

The demand for and frequency of virtual visits have increased dramatically over the past couple of years. The costs will vary depending on which type of coverage you have. Enrolling in a supplemental Medicare plan will lower the costs you pay for your doctor visits and health services, such as copays, coinsurance, and deductibles.

How many doctor visits does Medicare cover?

The frequency of some forms of covered doctor visits, such as the Medicare Annual Wellness Visit, may be limited. Additionally, some preventive services are also limited to a schedule. For example, diagnostic tests for heart disease are only authorized every several years.

You should schedule your appointments as directed by your healthcare provider. Everyone has different needs, so there is no way to determine exactly how many visits you‘ll have per year.

What is the Medicare copay for doctor visits?

The Medicare-approved amount can vary depending on where you live and the type of healthcare provider you see. The lowest cost office visit would be an appointment with your primary care provider. Specialists and other office visits may have a higher cost share or copay, depending on how you receive your Medicare coverage.

For example, let’s assume that the Medicare-approved amount in your area is $160, and your healthcare provider accepts Medicare assignment.

If you‘re enrolled in only Original Medicare, once you meet your Medicare Part B deductible, you‘ll be responsible for a 20% coinsurance. For the example shown, you’d pay a $32 coinsurance for your doctor‘s visit.

If you added a Medicare Supplement plan to your Original Medicare, the plan you choose would determine how much you pay. Most Medicare beneficiaries are enrolled in a Plan F, Plan G, or Plan N. Plan F and Plan G will pay all of your Part B coinsurance. Plan N is up to a $20 copay for doctor visits. That includes both primary care providers and specialists.

If you’re enrolled in a Medicare Advantage plan, you would be responsible for the Medicare Advantage plan copay outlined in your plan‘s benefit schedule. Depending on the medical insurance plan you choose, your costs will vary.