What Does Medicare Part B Cover? Free Coverage Checker 2026
Last verified against CMS.gov and Medicare.gov in September 2026.
Quick Answer
Medicare Part B covers two categories: medically necessary services (doctor visits, outpatient surgery, DME, mental health, ambulance) and preventive services (vaccines, screenings, annual wellness visits). For medically necessary services, you pay 20% coinsurance after the $283 annual deductible — with no annual out-of-pocket cap. Many preventive services are $0 with no deductible or coinsurance. Part B does NOT cover routine dental, vision, hearing aids, or home prescription drugs.
You have a doctor's appointment, a piece of equipment your doctor recommended, or an upcoming procedure — and you need to know, before it happens, whether Medicare Part B will pay and exactly what you will owe. Generic coverage articles list categories in paragraph form and force you to hunt for your specific situation. We looked at every service category Medicare officially addresses and built this tool so you get a direct answer for your specific service in seconds, not minutes.
- Is this specific service, item, or procedure covered by Medicare Part B?
- Does the $283 deductible apply, or is this a $0 preventive benefit?
- What will this realistically cost me based on my deductible status this year?
- If it's not covered — what are my actual alternatives?
Check Your Medicare Part B Coverage
Select any medical service or item to check if Medicare Part B covers it and calculate your out-of-pocket costs.
Choose a service from the list above
Pick any medical visit, procedure, equipment, or service from the dropdown above to view its 2026 Medicare Part B coverage verdict and estimated out-of-pocket costs.
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How to Use This Medicare Part B Coverage Checker
- Step 1 — Select your service from the dropdown list. Choose any item from the 55 Medicare services in the list. You can filter by category (like Preventive Services, DME, or Outpatient Surgery) or click one of the quick-pick buttons (such as "Flu Shot", "Wheelchair", or "Doctor's Visit") to jump directly to it with zero typing.
- Step 2 — Select whether you've met your $283 Part B deductible for 2026. If you've already paid $283 in Part B-covered costs this year, select "Yes." If not, select "No." If you're unsure, select "Not sure" and the tool will show you both scenarios side by side.
- Step 3 — Optionally select your income bracket. If you pay an IRMAA income surcharge on your Medicare premium, selecting your bracket shows your actual total monthly Part B cost alongside the service result — so you see the complete financial picture, not just the one-time service cost.
- Step 4 — Read your result. You'll see: a plain covered/not-covered verdict, the cost-sharing rules for your specific situation, an illustrative dollar example, any important nuances (like frequency limits for preventive services), and relevant next steps.
💡 Before Your Appointment
This tool tells you the coverage rule. Your provider's billing office can tell you the specific Medicare-approved amount for your exact procedure code. Before a major service, call the billing office and ask: "What is the Medicare-approved amount for this CPT code?" Then you can calculate your 20% share in advance and confirm your provider accepts Medicare assignment (agrees to charge only the Medicare-approved amount).
Real-Life Scenarios — How Part B Coverage Works in Practice
These two examples demonstrate how Medicare Part B coverage rules, deductibles, and cost-sharing play out for beneficiaries facing common medical needs.
Margaret, 71 — Scheduling a Screening Colonoscopy
Margaret has Original Medicare without a Medicare Advantage plan. Her primary care doctor recommended a routine screening colonoscopy every 10 years (or every 24 months if high-risk). She looked up "Colonoscopy (screening)" in this tool to check her potential costs before scheduling.
Robert, 67 — Prescribed a CPAP Machine for Sleep Apnea
Robert was diagnosed with obstructive sleep apnea and prescribed a CPAP machine. He had not used any medical services yet this year, meaning his $283 annual Part B deductible was completely unmet. He checked "CPAP machine (Durable Medical Equipment)" in this tool.
Three Costly Mistakes to Avoid with Medicare Part B
Mistake 1: Assuming all preventive visits are completely free ($0)
Medicare covers preventive services like the Annual Wellness Visit at $0 coinsurance. However, if you discuss a new health symptom or receive care for an existing medical condition during that same appointment, your provider must bill that portion as a separate diagnostic evaluation.
The fix is: inform your provider's reception desk when scheduling that you are booking a routine preventive visit. If an unexpected condition is discussed during the visit, ask whether it will generate a separate diagnostic billing charge.
Mistake 2: Believing Medicare Part B has an annual out-of-pocket maximum
Unlike private employer insurance or Affordable Care Act plans, Original Medicare Part B has no annual limit on your 20% coinsurance obligations. If you undergo major surgery or require extended outpatient chemotherapy, your 20% responsibility can reach tens of thousands of dollars without a ceiling.
The fix is: look into a Medigap (Medicare Supplement) plan such as Plan G or Plan N to cover the 20% coinsurance gap. Estimate your Medigap costs here →
Mistake 3: Failing to verify if your doctor accepts Medicare assignment
Doctors who do not accept Medicare assignment (participating providers) can charge up to 15% above the Medicare-approved amount, which is known as a Part B excess charge. You are personally responsible for paying this entire difference out of pocket.
The fix is: call your doctor's office before every specialist visit and ask: "Do you accept Medicare assignment?" If they say no, confirm what excess charges you will be expected to pay.
Medicare Part B Coverage at a Glance — 2026 Quick Reference
The following table summarizes coverage categories. Use the search tool above for the full detail on any specific service.
| Category | Covered? | Deductible | Your Share |
|---|---|---|---|
| Doctor visits & specialist care | ✓ Covered | $283 applies | 20% coinsurance |
| Annual Wellness Visit & preventive visits | ✓ Covered | No deductible | $0 |
| Vaccines (flu, COVID-19, pneumococcal, hepatitis B) | ✓ Covered | No deductible | $0 |
| Cancer screenings (mammogram, colonoscopy, PSA, lung CT) | ✓ Covered | No deductible | $0 (screening only; therapeutic portion may differ) |
| Outpatient surgery & procedures | ✓ Covered | $283 applies | 20% coinsurance — no annual cap |
| Durable medical equipment (wheelchair, CPAP, oxygen) | ✓ Covered | $283 applies | 20% coinsurance |
| Mental health & behavioral health (outpatient) | ✓ Covered | $283 applies | 20% coinsurance (parity with physical health) |
| Ambulance (emergency & medically necessary) | ✓ Covered | $283 applies | 20% coinsurance |
| Skilled home health (doctor-ordered, homebound) | ✓ Covered | No deductible | $0 (skilled care only — not custodial care) |
| Acupuncture (chronic low back pain only) | ~ Conditional | $283 applies | 20% coinsurance; max 12–20 visits/year |
| Routine dental (cleanings, fillings, dentures) | ✗ Not Covered | — | Full cost |
| Routine vision exams / eyeglasses | ✗ Not Covered | — | Full cost |
| Hearing aids / routine hearing exams | ✗ Not Covered | — | Full cost |
| Prescription drugs (taken at home) | ✗ Not Covered | — | Covered by Part D |
| Long-term custodial care | ✗ Not Covered | — | See Medicaid eligibility |
The Single Biggest Risk in Part B: No Annual Out-of-Pocket Cap
Most people assume Medicare covers everything after a small deductible. The reality of Original Medicare Part B is different: there is no annual limit on the 20% you owe. This is the most consequential fact about Part B cost structure, and it affects planning decisions significantly.
| Medical Service (Example) | Total Billed Charge | Your 20% with No Medigap | Your Cost with Medigap Plan G |
|---|---|---|---|
| Outpatient surgery | $25,000 | $5,000 | $0 (after $283 deductible) |
| Chemotherapy course (typical) | $60,000 | $12,000 | $0 (after $283 deductible) |
| Major trauma / critical illness | $200,000 | $40,000 | $0 (after $283 deductible) |
These are illustrative examples based on typical Medicare-approved amounts — not guaranteed figures for any specific service. But they show why the no-cap rule matters. A Medigap (Medicare Supplement) plan covers the 20% coinsurance that Original Medicare leaves unpaid.
Tools that address this exposure:
- Original Medicare + Medigap + Part D Cost Estimator — See your total annual cost with and without a Medigap policy
- Medigap Plan Comparison Tool — Compare Plans G, N, A, and F side by side
- Medicare Worst-Case Exposure Calculator — Model your maximum liability under each Medicare path
What Medicare Part B Does Not Cover — And Your Alternatives
Cleanings, fillings, extractions, root canals, dentures, and bridges are excluded from Part B. Part A covers dental services that are directly integral to a covered inpatient hospital procedure — nothing routine.
Alternatives: Many Medicare Advantage plans include routine dental allowances. Standalone dental insurance is available at any age. Federally Qualified Health Centers (FQHCs) offer sliding-scale dental care. Full guide: Medicare and dental/vision/hearing coverage →
Routine eye exams for eyeglass or contact lens prescriptions, and the eyeglasses or contacts themselves, are excluded. Exception: one pair of standard frames is covered after cataract surgery with an intraocular lens implant.
Alternatives: Medicare Advantage plans often include annual vision allowances. Standalone vision insurance is widely available. Full guide: Medicare and dental/vision/hearing coverage →
Hearing aids and the exams to fit them are excluded. Important distinction: diagnostic hearing tests ordered by a doctor to investigate a medical concern are covered under Part B at 20% coinsurance.
Alternatives: Some Medicare Advantage plans include hearing aid allowances. A free SHIP counselor can identify plans in your area — call 1-877-839-2675 or visit shiphelp.org. Full guide: Medicare and dental/vision/hearing coverage →
Most drugs you take at home are excluded from Part B. They're covered by Medicare Part D. Key exceptions covered under Part B: drugs administered by a provider in an office or clinic (infusions, injections), certain oral cancer drugs, and immunosuppressant drugs after a covered organ transplant.
Alternatives: Part D Prescription Cost Estimator → | Medicare Donut Hole Calculator →
What to Check Next
Common Questions About Medicare Part B Coverage
What does Medicare Part B actually cover?
Medicare Part B covers two broad categories: (1) medically necessary services — doctor visits, specialist care, outpatient surgery, diagnostic tests, durable medical equipment, mental health services, and ambulance — and (2) preventive services — annual wellness visits, vaccinations, and cancer screenings. For medically necessary services, you pay 20% coinsurance after the $283 annual deductible, with no annual out-of-pocket cap. Many preventive services are covered at $0.
How much is the Medicare Part B deductible in 2026?
The Medicare Part B annual deductible for 2026 is $283. You pay this amount once per year before Medicare starts sharing the cost for covered non-preventive services. After meeting the deductible, Medicare pays 80% of the approved amount and you pay 20% — with no annual cap on that 20%.
Does Medicare Part B cover preventive services at no cost?
Yes. Many Medicare Part B preventive services carry $0 cost-sharing — no deductible, no coinsurance — when Medicare's frequency and eligibility rules are met. These include the Annual Wellness Visit, flu and COVID-19 vaccines, mammograms, colonoscopies, diabetes screenings, and more. However, if your doctor performs additional services beyond the preventive scope during the same visit, those extra services may be subject to the deductible and 20% coinsurance.
What does Medicare Part B not cover?
Medicare Part B does not cover routine dental care (cleanings, fillings, dentures), routine vision exams or eyeglasses, hearing aids or routine hearing exams, prescription drugs taken at home (covered by Part D), long-term custodial care, or cosmetic surgery. These are explicitly excluded from Part B coverage.
Is there an annual out-of-pocket limit on Medicare Part B?
No. Original Medicare Part B has no annual out-of-pocket cap on the 20% coinsurance. If you have a major illness requiring $100,000 in Part B-covered services, your share would be approximately $20,000 — with no ceiling. This unlimited exposure is why many beneficiaries purchase a Medigap supplemental policy, which covers the 20% coinsurance.
Does Medicare Part B cover durable medical equipment like wheelchairs and CPAP machines?
Yes. Medicare Part B covers durable medical equipment (DME) — including wheelchairs, walkers, hospital beds, oxygen equipment, blood glucose monitors, CPAP machines, prosthetics, and orthotics — when a doctor prescribes them as medically necessary and you purchase or rent from a Medicare-enrolled DME supplier. You pay 20% coinsurance after the $283 annual deductible.
Does Medicare Part B cover mental health services?
Yes. Medicare Part B covers outpatient mental health services — including psychotherapy, psychiatrist visits, and partial hospitalization programs — at the same 20% coinsurance rate as physical health services. Federal mental health parity law requires Medicare to apply equal cost-sharing for mental and physical health care. Licensed psychologists, clinical social workers, and nurse practitioners can provide covered mental health services under Part B.
Does Medicare Part B cover ambulance transport?
Yes. Medicare Part B covers ground and air ambulance transport in emergency situations when other transport would endanger your health. Non-emergency ambulance is covered when a doctor certifies it is medically necessary. You pay 20% coinsurance after your deductible. The ambulance service must be Medicare-enrolled.
Does Medicare Part B cover home health care?
Medicare Part B covers skilled home health services — such as skilled nursing care and physical therapy — at 100% (no deductible, no coinsurance) when a doctor orders the services, you are homebound, and the agency is Medicare-certified. Important: this covers skilled care only, not long-term custodial care (help with bathing, dressing, meals).
How do I find out if a specific service is covered by Medicare Part B?
The Medicare Part B Coverage Checker tool above lets you search any service by name and instantly see coverage status and cost-sharing rules. You can also check Medicare's official coverage lookup at medicare.gov/coverage, or call 1-800-MEDICARE (1-800-633-4227). A free SHIP counselor in your state can also help you verify coverage for a specific upcoming service — find yours at shiphelp.org.
About This Educational Estimate: This tool is for educational purposes only. Seniors Audit uses the official formulas published by CMS (Centers for Medicare & Medicaid Services) and Medicare.gov, but results are estimates based on the information you entered. Rules, rates, and eligibility thresholds change annually and vary by individual circumstance.
Always verify your specific result directly with CMS (Centers for Medicare & Medicaid Services) and Medicare.gov at 1-800-MEDICARE (1-800-633-4227) or at www.medicare.gov before making enrollment, coverage, or financial decisions.
If you have Medicare questions, a free SHIP counselor in your state can review your specific situation at no cost — find yours at shiphelp.org.
Seniors Audit is independent and not affiliated with any government agency or insurance company. We are not affiliated with, endorsed by, or connected to any government agency, insurance company, or financial services firm. All calculations use the official formulas and current figures published by the agencies listed above. We do not receive payment for referrals, leads, or any action taken by visitors to this site. Last reviewed: September 2026.
Sources Used in This Tool
| Source Name | What We Used It For | Direct Link |
|---|---|---|
| CMS 2026 Medicare Parts A & B Premiums and Deductibles Fact Sheet | Official authority for the 2026 Part B deductible ($283), standard base monthly premium ($202.90), and statutory coinsurance rules | cms.gov → |
| Medicare.gov — What Part B Covers (Official Coverage Database) | Beneficiary-facing database used to cross-reference coverage verdicts, doctor visit requirements, and coinsurance across all 55 listed services | medicare.gov/coverage → |
| Medicare.gov — Preventive & Screening Services Coverage Rules | Authoritative eligibility rules, frequency requirements, and $0 cost-sharing criteria for mammograms, colonoscopies, vaccines, and wellness visits | medicare.gov/preventive → |
| CMS DMEPOS Fee Schedule & Coverage Guidelines | Official coverage guidelines and assignment standards for durable medical equipment (wheelchairs, CPAP, oxygen, walkers) under Part B | cms.gov/dme → |
Seniors Audit is an independent educational platform. We are not affiliated with, endorsed by, or compensated by CMS, Medicare.gov, SSA, or any commercial insurance carrier. All coverage determinations and dollar figures on this page are drawn directly from official federal publications. Always confirm specific procedure codes and coverage with your healthcare provider and 1-800-MEDICARE.