doctor visits covered by medicare

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Does Medicare cover doctor visits?

Medicare Part B is the part of original Medicare that covers the costs of doctor visits. Part C, or Medicare Advantage, also provides this coverage.

Medicare is a federally funded insurance plan consisting of four parts: Part A, Part B, Part C, and Part D . Each part covers different medical expenses.

In 2020, Medicare provided healthcare benefits for more than 61 million older adults and other qualifying individuals.

Today, it primarily covers people who are over the age of 65 years, but younger people with end stage kidney disease and 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.

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.

What parts of Medicare cover doctor visits?

two senior people asking a doctor if does medicare cover doctor visits

Original Medicare comprises Part A, which is hospital insurance, 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.

Medically necessary services are those that the doctor uses to identify a medical condition when someone presents with symptoms and to provide them with treatment.

Preventive care helps prevent illnesses or stop early stage conditions from progressing. This type of care includes flu shots and screenings, such as cholesterol checks, Pap smears , and mammograms.

Some preventive services have no associated costs when a doctor agrees to accept assignment. This means that the doctor has a contract to bill Medicare directly.

Part B may also pay for other services, such as an ambulance, certain prescription drugs, and durable medical equipment. People can check whether their plan covers the test or service they need using Medicare’s online tool .

Medicare Part C (Medicare Advantage plans)

Medicare Part C plans, also known as Medicare Advantage plans, are 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 visits to the doctor.

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

Medicare resources

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

When does Medicare not cover doctor visits?

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
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

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

How much does Medicare pay for a doctor visit?

Everyone with Medicare is entitled to a yearly wellness visit that has no charge and 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 $203 in 2021. The deductible is the amount of money that a person pays out of pocket before the insurance begins to cover the costs.

A person will also need to pay a premium to keep the policy. The standard monthly premium in 2021 is $148.50.

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 associated with 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 Part B and Medicare Advantage plans cover visits to the doctor. These plans help people with health insurance plans pay for medically necessary and some preventive care.

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

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

A note on insurance

The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products.

Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.

Last medically reviewed on June 25, 2021

Health Insurance / Medical Insurance
Medicare / Medicaid / SCHIP
Primary Care

How we reviewed this article:

Doctor & other health care provider services. (n.d.). https://www.medicare.gov/coverage/doctor-other-health-care-provider-services
Items & services not covered under Medicare. (2020). https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Items-Services-Not-Covered-Under-Medicare-Text-Only.pdf
Medicare Advantage plans. (n.d.). https://www.medicare.gov/sign-up-change-plans/types-of-medicare-health-plans/medicare-advantage-plans
Medicare costs at a glance. (n.d.). https://www.medicare.gov/your-medicare-costs/medicare-costs-at-a-glance
Part B costs. (n.d.). https://www.medicare.gov/your-medicare-costs/part-b-costs
Part B late enrollment penalty. (n.d.). https://www.medicare.gov/your-medicare-costs/part-b-costs/part-b-late-enrollment-penalty
Total number of Medicare beneficiaries. (n.d.). https://www.kff.org/medicare/state-indicator/total-medicare-beneficiaries/?currentTimeframe=0&selectedDistributions=total&selectedRows=%7B%22wrapups%22:%7B%22united-states%22:%7B%7D%7D,%22states%22:%7B%22all%22:%7B%7D%7D%7D&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D
Your Medicare benefits. (2021). https://www.medicare.gov/Pubs/pdf/10116-Your-Medicare-Benefits.pdf
What part B covers? (n.d.). https://www.medicare.gov/what-medicare-covers/what-part-b-covers
What's Medicare? (n.d.). https://www.medicare.gov/what-medicare-covers/your-medicare-coverage-choices/whats-medicare

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Does Medicare cover doctor visits?

What’s covered | Virtual visits | How many visits does Medicare cover? | Cost of doctor visits

Our doctors become more important to our healthcare as we get older. They are an essential part of our aging gracefully and staying healthy. For many Medicare beneficiaries , seeing their doctors consistently helps catch health concerns before they become a problem.

Most doctors prefer to see you at least once a year to discuss changes in lifestyle, health risks, and vitals. They use this information to formulate a plan to help you stay healthy. When enrolled in certain health insurance plans the frequency with which you’re advised to see your healthcare provider can be increased.

Does Medicare cover doctor visits ?

Medicare does cover visits to your doctor, specialists, health screenings , urgent care, mental health , and emergency room visits. The coverage extends to all medically necessary visits and services.

Which parts of Medicare cover doctor visits ?

Original Medicare refers to Medicare Part A and Medicare Part B . Medicare Part A covers your inpatient hospital stays , skilled nursing facility services, and hospice care.

Medicare Part B covers your doctor visits , durable medical equipment , and medical services you receive in outpatient settings. 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 doctor does not accept Medicare assignment

Original Medicare doesn’t include coverage for prescription drugs . Drugs that are purchased at a pharmacy are covered by enrolling in either a standalone Part D Prescription drug plan or a Medicare Advantage plan that includes prescription drug coverage .

If you want to safeguard yourself from these and other additional costs, you can enroll in Medicare supplemental insurance , otherwise known as a Medigap . These plans are additional insurance that is designed to fill the gaps of what Original Medicare doesn’t pay. Medigap plans have a fixed monthly premium and low to no out-of-pocket costs when you use Medicare-approved services.

Medicare Part C combines your Medicare Part A hospital insurance and Medicare Part B medical services benefits in a simple-to-use all-in-one plan. These plans are also called Medicare Advantage plans and are administered by private insurance companies . When using a Medicare Advantage plan , you pay based on the cost structure of the plan you choose.

When you visit a healthcare provider with Medicare Advantage insurance, 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 .

Keep in mind the benefits of Part C plans will be different depending on which plan and the insurance company you decide to choose.

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

What’s 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 there are a few things that are not.

Dentist appointments aren‘t 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 aren’t covered for routine services such as exams, and hearing aids.
Cosmetic procedures aren‘t covered by Medicare.
Podiatrist appointments for routine services such as toenail trimming, and callous, or corn removal.
Chiropractic services are only covered for treating vertebral subluxation of the spine.
Preventive services outside of the Medicare schedule.

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

Some Medicare Advantage plans offer coverage for:

Chiropractic

All plans are different depending on where you live and which plan you choose. Check with your plan‘s benefit schedule to ensure the coverage you are looking for is included.

Does Medicare cover virtual doctor visits ?

Virtual doctor visits are 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 and frequency that virtual visits are used 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 .

How many doctor visits does Medicare cover?

There is no limit to the number of doctor services covered by Medicare. 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.

How much do doctor visits cost with Medicare?

The Medicare-approved amount can vary depending on where you live. The lowest costing office visit would be an appointment with your primary care doctor. Specialist and other office visits will have a higher cost share or copay depending on your plan.

For example, Let’s assume that the Medicare Approved amount in your area is $160 and your doctor accepts your 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 co-pay outlined in your plan‘s benefit schedule. Depending on the medical insurance plan you choose your costs will vary. RELATED: What’s the difference between a copay vs. deductible ?

Medicines prescribed by your doctor

For many Medicare beneficiaries , the majority of office visits are to follow up on labs and make sure prescription levels are correct and working properly. There are many times your provider will send a prescription to your pharmacy.

Unless the medication is administered in the doctor’s office , medications may be covered by your Medicare Part D prescription drug coverage or Medicare Advantage plan . In most cases, your healthcare provider will check with your plan to make sure the drug they are prescribing is on your plan‘s formulary . However, there are times when something may not be covered by your plan, or the cost of your plan is more than you can afford.

If the drug is expensive but is covered by your plan you can check to see if you qualify for the Medicare Extra Help program . This program is designed to help Medicare beneficiaries that have low-income and limited resources pay for their prescription drugs .

Your eligibility for Extra Help is determined by your household income. You can apply with the Social Security Administration either online, in person, or over the phone. If your income is too high to qualify for this program, you can use a SingleCare free discount card to help lower your prescription drug costs. Using a SingleCare drug coupon in place of your coverage may greatly reduce the cost of your prescription. You can email, text, or download your SingleCare card and start saving in minutes.

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Does Medicare Cover Doctor Visits?

Having access to a physician who can address your concerns, diagnosis medical issues, and treat you is absolutely essential, especially as we age. When you first become eligible for Medicare when you turn 65, you have the option of enrolling in Medicare Part B (Medical Insurance.) Most people choose to enroll in Part B as soon as they are eligible to avoid late enrollment penalties when they join after their initial enrollment period has ended, but enrolling in Part B isn’t just a financial decision. Part B coverage can make a big difference in your overall health, now and in the future.

Seeing a Physician – Medicare Part B Benefits

Medicare Part B helps cover the cost of medically necessary services and supplies that meet accepted standards of medical practice in a physician’s office or outpatient setting in order to diagnose and treat a medical condition. Part B includes coverage for ambulance services, clinical research, inpatient and outpatient mental health care, a second opinion before surgery, and durable medical equipment (DME). DME includes medically necessary equipment you need to use in your home and that is prescribed by a physician.

Part B also covers a wide range of preventive services, including a Welcome to Medicare visit when you are first enrolled, and annual Wellness visits after you have had Part B for 12 months. These annual exams can serve as great opportunities to build a rapport with your doctor, discuss your family medical history, and keep track of any changes in your physical or mental health.

Do You Have to See Specific Doctors?

When you become eligible for Medicare, you have the choice to get your Part A and/or Part B benefits through Original Medicare, the federal program that administers your coverage, or through a Medicare Advantage plan, offered by private insurance companies that contract with Medicare to provide your Part A and Part B benefits. If you have Original Medicare Part B, you may visit any doctor who is participating in Medicare and accepts assignment. You do not need referrals from a primary doctor in order to see a specialist. You can visit any specialist that accepts assignment, as well. You will likely pay 20% of the Medicare approved amount and the Part B deductible may apply.

If you choose to enroll in a Medicare Advantage plan, you will have at least the same Part A and Part B benefits as Original Medicare, but many MA plans provide additional coverage, including prescription drug coverage, vision and dental care, and annual out-of-pocket maximums. If you are enrolled in a Medicare Advantage plan, you will likely have to visit doctors and specialists that belong to your plan’s network. If you go outside of the plan’s network, you may be responsible for the full amount of any medical care you receive.

What is Medicare?

Medicare.org Frequently Asked Questions (FAQ)

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Does Medicare Cover Doctor Visits?

Yes, Medicare covers doctor’s visits if they’re medically necessary . If you have Original Medicare , visits are covered by your Part B insurance. Costs can vary depending on the type of visit and whether or not your doctor accepts the Medicare-approved amount for payment. Knowing what Medicare does and doesn’t cover before your next visit can help you better plan your medical expenses.

The importance of regular checkups.

The U.S. Preventive Services Task Force recommends that adults aged 65 see their doctors for a routine checkup regularly; at least once a year. Unfortunately, many people aren’t taking that advice, as 44% of people are overdue for a regular checkup .

During these checkups, a doctor can assess you for any emerging medical issues, identify your risk of future problems, and help you maintain a healthy lifestyle. A study on the impact of routine general screenings found that patients with regular health checks tend to have increased chronic disease recognition and treatment . They also received more preventive services and had better patient-reported outcomes.

What Types of Doctor Visits and Outpatient Services Does Medicare Cover?

Medicare covers many different kinds of doctor visits. You must have an underlying health condition or risk factor to be eligible for many of these services. Usually, Medicare pays for 80% of covered visits, meaning you pay the other 20% . Here’s a closer look at the types of doctor visits and outpatient services that Medicare typically covers.

Preventative Services

Preventive services help you catch health problems early on before they’re an issue. Medicare covers dozens of preventive and screening services if you have certain risk factors, including:

Abdominal aortic aneurysm screenings
Cardiovascular disease screenings
Colorectal cancer screenings
Diabetes screenings
Flu and vaccine shots
HIV screenings
Nutrition therapy services
Obesity screenings and counseling

Medicare also covers an annual wellness visit . This is a chance for your provider to take routine measurements, ask you about your family and medical history, and address any concerns you might have about your health. You may also receive a cognitive assessment to check for warning signs of dementia.

Medical Services

During a doctor’s visit, if your provider recommends you get a certain test or procedure, Medicare Part B might cover the bill. These services have to be medically necessary, meaning they’re needed to diagnose or treat a disease, condition, illness, or injury. They differ from preventive services because they’re done when a doctor suspects you have a certain condition or wants to treat you for a condition.

Some of the medical services that may be covered after your doctor’s recommendation include:

Clinical laboratory tests
Colonoscopies
Dialysis services and supplies
Fecal occult blood tests
Opioid use disorder treatment services
Prosthetic devices
Sleep studies

Specialist Visits

Sometimes, you might need care from a specialist provider. Medicare offers coverage for these types of outpatient services as well. For example, if you need mental health care , your Part B benefits cover one depression screening per year, individual and group psychotherapy, and family counseling.

You may also be covered for other types of therapy, like physical therapy , occupational therapy, and speech-language pathology therapy, as long as your doctor prescribes it. Certain types of specialists, such as dentists, podiatrists, optometrists, or chiropractors, may be covered by Medicare if you have an underlying condition that requires treatment.

What Kinds of Doctor Visits Does Medicare Not Cover?

Medicare does not cover every type of doctor visit. For example, routine physical checkups are not covered unless you have a specific issue. Also, routine eye examinations and dental services usually aren’t covered. There are a few exceptions, like if you have an eye disease like glaucoma or need a tooth extraction to prepare for radiation treatment.

Other non-covered services include:

Hearing aid examinations
Chiropractor visits not involving manual manipulation of the spine
Routine foot care
Follow-up care after a hospital stay for a non-covered service
Massage therapy

Wellness Visits

In contrast to physicals , Medicare recipients are entitled to an annual wellness visit. This is a yearly visit that is covered under Medicare Part B. During this visit, the doctor will review the patient’s medical history and current health status, check vital signs, and assess the patient’s risk factors for certain diseases.

The doctor will also develop a personalized prevention plan that includes recommendations for preventive screenings, vaccinations, and lifestyle changes.

How Medicare Covers Your Visits to the Doctor

Your Medicare Part B benefits cover your visits to the doctor. However, you must pay your annual deductible before your services or visits are covered. For 2023, this is $226. This isn’t an additional fee; it’s the amount you pay in covered medical bills before Medicare kicks in.

Medicare has an established rate it pays out for each covered service it offers. If a doctor agrees to this rate, it’s called accepting assignment. When you go to providers that accept assignment, the Medicare copay for doctor visits is 20%. Going to providers that accept assignment can mean lower out-of-pocket costs for you.

If your provider refuses to accept the Medicare-approved amount, they can charge up to 15% more . You would be responsible for paying this 15% difference.

In some cases, providers opt out of Medicare entirely. This means Medicare doesn’t pay anything toward a visit; you would have to pay 100% of the costs yourself. The exception is if you’re in an emergency.

How Medigap Coverage Helps

Medigap plans are add-on medical supplemental insurance that can help you pay for your Medicare copayments, coinsurance, and deductibles. You pay a monthly premium ; in return, you might pay less on some of your medical bills.

A few plans can help you pay for doctor visit costs. Plan K can cover 50% of your Part B coinsurance, while Plan L can cover 75%. The following plans cover your Part B coinsurance at 100%:

Unfortunately, new Medigap plans no longer cover the Part B deductible , so you must pay that on your own.

How Medicare Advantage Covers Your Visits to the Doctor

Some people choose to enroll in a private Medicare plan called Medicare Advantage. Sometimes called Part C, Medicare Advantage plans are managed by private insurers and follow strict rules to ensure you get the same level of coverage as you would with Original Medicare.

However, many plans provide extra benefits. For example, some plans may include coverage for dental services, massage therapy, and chiropractor services.

Additionally, costs work differently with Part C plans. Each plan has its rules on your deductible, copayments, and coinsurance. However, one crucial difference is that these plans come with an out-of-pocket limit, the maximum amount you must pay in medical bills each year before your expenses are covered at 100%. Original Medicare doesn’t have an out-of-pocket max, meaning you keep paying copayments no matter what.

Medicare Coverage of Telehealth

Telehealth lets you receive medical services at your home through video or audio technology. For example, you might get on a video call with your doctor to ask about specific symptoms. Through telehealth, doctors can examine, diagnose, and treat you like they would at an in-person visit. If necessary, they can also prescribe medications.

Like in-person doctor visits, Medicare covers telehealth visits at 80% after you pay your Part B deductible. This means you pay 20% of the cost of each visit. However, this coverage is temporary until December 31, 2024. After that time, to be eligible to receive telehealth services , you must meet one or more of these criteria:

Live in a rural area without easy access to healthcare
Have monthly end-stage renal disease visits
Need a diagnosis, evaluation, or treatment of symptoms from an acute stroke, mental health disorder, or substance use disorder

Medicare Coverage of Doctor-prescribed Medication

Original Medicare usually doesn’t cover prescription medication. There are a few exceptions if you have specific medical conditions, but for many people, an easy way to get medication coverage is with Part D.

Medicare Part D is an add-on plan that specifically covers the drugs your doctor prescribes. Private insurance companies manage these plans, so each differs. For example, every plan comes with a unique formulary; the list of prescription drugs it covers.

Another option is to enroll in a Medicare Advantage plan. These usually bundle prescription drug coverage, so you don’t need to deal with multiple plans. MA plans also bundle Medicare Part A and B benefits.

What Are Your Options If Medicare Does Not Cover a Doctor You Need?

It’s possible that Medicare might not offer coverage for a doctor you want to see. If that’s the case, you have several options at your disposal.

Ask for a Referral to Another Provider

One option is to ask your primary care provider for a referral to another in-network provider. Chances are, they have a good network of doctors to recommend based on your specific needs.

Pay the Costs Out of Pocket

If you really want to see a specific doctor, you can pay for your visit out of pocket. Sometimes, doctors are willing to negotiate lower rates for patients without insurance.

Switch to a Medicare Advantage Plan

If you need to go to an out-of-network doctor regularly and not for a 1-time appointment, then it might be a good idea to consider switching to a Medicare Advantage plan. MA plans generally have a wider coverage network than Medicare and might be in-network with the provider you want to see.

What This Means For You

Medicare covers many doctor’s visits, from physical therapy sessions to annual wellness visits. It typically pays 80% of each visit. That leaves you with 20% coinsurance.

If you go to the doctor often, these costs can add up, so you may want to consider adding Medigap insurance. Another possible option is a Medicare Advantage plan with more comprehensive coverage. Medicare Advantage plans can cover additional visits like massage therapy or dental services.

Whether you’re sticking with Original Medicare or exploring other options, do your research before any doctor visit so you know what to expect regarding cost.

You’re just a few steps away from seeing your Medicare Advantage plan options.

Medicare Preventive Services: What's Covered

by David Levine
January 12, 2024
Reviewed by John Krahnert

The old saying goes that an ounce of prevention is worth a pound of cure. Change those measurements from pounds to dollars, and you see why Medicare puts so much emphasis on preventive services. As any doctor will tell you, it’s far less expensive to try to prevent illness than it is to treat it.

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The Affordable Care Act (sometimes called Obamacare) took this premise even further. While some preventive services still require a copayment or coinsurance, many others are now entirely free if you meet certain guidelines and age requirements.

Note : Typically, the following services are covered 100 percent by Medicare if your health care provider accepts assignment. Providers that accept Medicare assignment agree to accept the Medicare-approved amount as full payment for covered services. Medicare providers that do not accept assignment can charge up to 15 percent more than the Medicare-approved amount, which could mean higher out-of-pocket costs for you. Be sure to find out if your health care provider accepts assignment before getting any of the following services.

What doctor visits does Medicare cover?

There are basically three types of doctor visits that may include preventive care and can be covered by Medicare:

Your Welcome to Medicare visit

Certain preventive visits and screenings
Your annual wellness exam

New enrollees are often confused by the differences among these visits, because they are similar but not the same. It is always a good idea to clarify the type of visit you are scheduling before you book an appointment, so you know what services you are getting and what is or isn’t covered by Medicare.

It’s important to remember that a routine annual physical exam is not the same as your annual Medicare Wellness visit and is not a Medicare-covered service, meaning you will typically owe 100% of the amount due.

As the name implies, your Welcome to Medicare visit is something you schedule within the first 12 months that you have Medicare. At this visit, your doctor will go over your health and medical history, discuss your lifestyle and home welfare, and plan your future care, including preventive care. Typically, however, you do not receive preventive care at this visit – it is primarily a get-to-know-you interaction.

Your Welcome to Medicare visit may include:

A simple vision test
Height, weight and blood pressure check
Body mass index (BMI) check
Medical and social history–alcohol or tobacco use, diet, activity level
Depression and safety screenings
Discussions about creating advance directives
Advice and counseling on disease prevention and overall health maintenance

The Welcome to Medicare visit is free of charge to you, meaning it doesn’t require any Medicare Part B coinsurance or copays, and it doesn’t count toward your Part B deductible. It is only covered one time, and the appointment must be held within the first 12 months of enrolling in Medicare Part B.

A Medicare preventive care visit

A Medicare preventive visit is not the same as the Welcome to Medicare visit. You might visit your doctor for a standard preventive care visit to perform some of the tests and screenings that were suggested at your Welcome to Medicare visit, as needed.

A preventive visit is an opportunity to discuss your health with your doctor, including preventive services you may need.

Many screenings at a preventive visit are covered in full by Medicare, meaning you pay nothing out of pocket for the visit. But you may need some testing that does include costs such as Part B coinsurance or copayments, and you may potentially face some costs if your doctor decides you need additional treatment or diagnostic testing based on the results of your appointment.

The preventive exam doesn’t routinely cover some tests, such as lung exams and reflexes. However, if your doctor has discussed a symptom with you that requires that screening, Medicare may cover it.

A Medicare annual Wellness visit

A Medicare annual Wellness visit (AWV) is similar to a standard preventive care visit to your doctor intended to check on your health, prevent and avoid disease and create a plan to maintain wellness. But these types of visits are also different.

The yearly Wellness exam is your yearly check in , while preventive services are scheduled as needed. Once you have been enrolled in Part B for more than 12 months, you are eligible for a yearly Wellness visit.

The annual Wellness visit can include preventive services such as:

Health risk assessment
Height, weight, blood pressure and other routine measurements
Develop or update a list of current providers and prescriptions
Review of medical and family history
Cognitive impairment screening
Personal health advice
Your risk factors and treatment options
A personalized preventive services checklist

At the annual Wellness visit, you can make an appointment for any preventive care you need.

Medicare doesn’t cover routine physical exams

Medicare doesn’t cover routine physicals. You are accountable for 100% of costs for a routine physical, which can average from $50- $200 or more.

Does Medicare cover free tests and screenings?

According to Medicare.gov, the following tests and screenings can be covered by Medicare for free without out-of-pocket copays or coinsurance, depending on your situation and depending on whether your doctor accepts Medicare assignment:

Abdominal aortic aneurysm screening , a one-time screening for people at risk (family history of abdominal aortic aneurysms, or men between 65 and 75 who have ever smoked) who have a referral from their initial Welcome to Medicare visit or annual Wellness visit
Alcohol misuse screening and counseling , which can be part of your Welcome to Medicare or Annual Wellness Visit
Bone mass measurement , or bone density test , covered once every two years
Cardiovascular disease screening , covered every five years, along with one behavior therapy visit a year to talk about lowering your cardiovascular disease risk with your physician
Depression screening , once a year
Diabetes screening , up to twice a year for people at high risk of diabetes
Hepatitis B shots , for those at medium or high risk
Hepatitis C screening test , for those at high risk and with a doctor’s order
HIV screening , every 12 months for those under age 65. For those 65 and older, screening is only covered for high-risk individuals
Colorectal cancer screening , which may involve a fecal occult blood test, colonoscopy, flexible sigmoidoscopy and/or barium enema. Part B coinsurance may apply if polyps are found and removed during the screening, and if a barium enema is used during of screening
Lung cancer screening for current and former smokers
Mammogram each year, for screening only
Nutrition therapy services for patients with diabetes, kidney disease, or have had a recent kidney transplant
Obesity screening and counseling , for people with a BMI of 30 or more
Pap test and pelvic exam (including clinical breast exam ) every two years, or more often if at high risk
Pneumococcal shot
PSA screening for prostate cancer, with no charge for an annual PSA test, but with the Medicare Part B deductible and coinsurance for a digital rectal exam
Sexually transmitted infection screening and counseling , including screening tests for chlamydia, syphilis, gonorrhea and hepatitis B
Smoking cessation counseling

Some of the following tests and screenings may require you to pay a Medicare deductible, copay or coinsurance:

Diabetes self-management training , for people at risk of diabetes complications. You are responsible for your part B deductible if you haven’t already met it for the year, plus 20% of the Medicare-approved amount for the training.
Diagnostic mammogram ( a mammogram that has been ordered to diagnose an area of concern, as opposed to a routine screening test when no symptoms are present). You pay your Part B deductible if you haven’t already met it for the year, plus 20% of the cost of the Medicare cost for screening.
Digital rectal exam for prostate cancer. This will cost you the Part B deductible and coinsurance.
Glaucoma test if you are at risk. You’ll pay your part B deductible if you haven’t already met it for the year, plus 20% of the cost of the screening. A copay may also apply.

As of 2020, new Medicare beneficiaries cannot purchase a Medigap plan (also called Medicare Supplement Insurance) that covers the Part B deductible. However there are some types of Medigap plans that cover Part B coinsurance costs.

Medicare Advantage vs. Original Medicare

Medicare Advantage plans (also called Medicare Part C) are an alternative to Original Medicare that can provide benefits not found in Original Medicare.

Every Medicare Advantage plan must provide the same hospital and medical benefits as Medicare Part A and Part B, which means that the benefits listed in this article are covered by Medicare Advantage. Some Medicare Advantage plans may also cover preventive services that Original Medicare doesn't cover.

Speak with a licensed insurance agent to find Medicare Advantage plans in your area and to enroll in a plan that works for you.

Compare plans today.

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1-800-557-6059 | TTY 711, 24/7

About the author

David Levine is an award-winning writer and editor whose work has been featured in the New York Times, New York Daily News, Sports Illustrated, American Heritage, U.S. News & World Report and others.

David has covered health, health insurance and health policy topics – among many others – since 2017. He earned a Bachelor's Degree in English from the University of Rochester and currently lives in Albany, New York.

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Original Medicare (Parts A and B) doesn’t cover routine dental or vision care. 2024 Medicare Advantage (Part C) plans can cover benefits Original Medicare doesn’t cover, but dental and/or hearing benefits may not be available where you live. Learn more and find out how to compare the plans and benefits available in your area. Read more

Medicare Part B may cover emergency ambulance services, and some Medicare Advantage plans may offer non-emergency transportation to plan-approved locations. Learn more about Medicare transportation coverage. Read more

Medicare Advantage plans can offer gym memberships and fitness benefits that Original Medicare doesn’t cover, such as SilverSneakers. Learn how to compare your local plan options and how to find a Medicare Advantage plan that covers fitness benefits. Read more

While Original Medicare (Parts A and B) doesn’t cover hearing aids, Medicare Advantage (Part C) plans can cover hearing benefits Original Medicare doesn’t cover. Hearing benefits can be limited and may not be available where you live, so learn how to find out if Medicare Advantage plans that help pay for hearing aids are available in your area. Read more

Medicare Part B covers annual wellness visits. Medicare Advantage plans also cover annual wellness visits, and many Medicare Advantage plans also offer other wellness benefits not found in Original Medicare. Read more

Medicare Part A does not cover outpatient surgery, but Part B covers medically necessary outpatient surgery. Medicare Advantage plans may also cover outpatient surgery and include an annual out-of-pocket spending limit, which Original Medicare doesn’t offer. Read more

Original Medicare and Medicare Advantage plans can cover chiropractic care, but some plans may cover services more than others. Learn about what’s covered, what’s excluded and how much your Medicare costs could be. Read more

Medicare covers many telehealth services, and those benefits expanded during the coronavirus pandemic. Beneficiaries can use telehealth to access their doctor while also staying safe during COVID-19. Read more

Original Medicare (Medicare Parts A and B) doesn’t cover bathroom grab bars or other bathroom safety devices. Medicare Advantage plans can cover bathroom safety devices, but only in limited situations and only for beneficiaries who qualify. Read more

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Getting Your Telehealth Appointments Covered by Medicare

Wondering if your insurance will cover a virtual visit here's what you need to know.

Deborah Pike Olsen

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More than 10.1 million Medicare beneficiaries have received medical care via telemedicine since the coronavirus hit, thanks to an expansion of services and coverage during the pandemic. In recent months, the Centers for Medicare & Medicaid Services (CMS) has more than doubled the number of health care services beneficiaries can receive via telemedicine. The agency has allowed an additional 135 services, including home visits, eye exams and physical, occupational and speech therapy. In early August, CMS proposed covering some of these new services on a permanent basis. According to CMS Administrator Seema Verma, telemedicine has proven to be a boon for patients and physicians.

It's clear that telemedicine will continue to play a key role in health care for Medicare beneficiaries. “Telemedicine is more integrated into our lives now, so some of the changes in coverage are likely to stay,” says Mei Kwong, executive director of the Center for Connected Health Policy.

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What's included in the expanded/emergency coverage

Under the Coronavirus Preparedness and Response Supplemental Appropriations Act, which was signed into law in March, the secretary of the Department of Health and Human Services was allowed to waive certain Medicare telemedicine payment requirements during the public health emergency. This resulted in the following changes that affect coverage:

During the public health emergency, CMS is paying for telehealth services at the same rate as in-person visits. Original Medicare beneficiaries pay 20 percent of the Medicare-approved amount for a doctor's services, and the Part B deductible applies. However, the Families First Coronavirus Response Act waives cost sharing (coinsurance and deductibles) under Medicare Part B for COVID-19 testing-related services. In addition, the Office of the Inspector General is allowing doctors to waive the 20 percent copay for telemedicine visits.
More than half of Medicare Advantage (MA) plans now offer telemedicine services as part of the basic benefit. They may offer more telemedicine services than original Medicare. Many health plans are waiving cost sharing for MA beneficiaries. For example, Aetna is waiving out-of-pocket costs for in-network primary care and specialist telemedicine visits for individual and group MA plan members through Sept. 30. Cigna is waiving copays, deductibles and coinsurance for in-network medical or behavioral telemedicine visits for MA beneficiaries until the end of December.
Beneficiaries can have telemedicine visits at home. Prior to the pandemic, they had to live in a rural area and obtain services at a hospital, clinic or other medical facility.
You can see a broader range of health care professionals — physical and occupational therapists and speech-language pathologists, to name a few — and you don't need an established relationship with a health care provider in order to receive care. (Prior to the pandemic, only doctors, nurse practitioners, physician assistants or other health care providers could see you via telemedicine.)
You can see a provider who is licensed to practice in another state.
You can use a smartphone, tablet or computer for a telemedicine visit. In addition, you can use a videoconferencing service you're familiar with, such as FaceTime or Skype.
You can have a phone visit with your doctor. Phone visits are covered at the same rate as office visits. The types of appointments that can be conducted on the phone have been expanded to include patient education and behavioral health services. More than 3 million beneficiaries have had telemedicine visits over the phone.
You can have a “virtual check-in,” in which you communicate briefly with a doctor, nurse practitioner or physician assistant through a patient portal, email, video, secure text messaging or phone. These visits are often done to determine whether you need an office visit, and you don't need to be an established patient. In addition, Medicare covers e-visits, during which you communicate with your doctor or other provider (nurse practitioner, social worker or physical therapist, for instance) via an online patient portal. Normally, you'd pay 20 percent of the Medicare-approved amount for these services, and the Part B deductible applies. However, CMS is allowing health care providers to waive cost sharing for telemedicine visits.

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The Most Popular Telehealth Visits For Medicare Recipients

During the first few months of the pandemic, the most common type of telemedicine visit was related to an illness. Nearly 5.8 million enrollees have had this type of visit since the public health emergency began. Mental health services have also been popular; about 60 percent of beneficiaries who received care from a psychologist or psychiatrist did so via telemedicine. About 26 percent of beneficiaries in nursing homes had a telemedicine visit. Finally, about 19 percent of the 1.5 million beneficiaries who had preventive health visits — such as annual wellness visits, depression screenings and diabetes self-care training — during the pandemic did so via telemedicine.

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Get Your Medicare Wellness Visit Every Year

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Take Action

If you have Medicare, be sure to schedule a yearly wellness visit with your doctor or nurse. A yearly wellness visit is a great way to help you stay healthy.

What happens during a yearly wellness visit?

First, the doctor or nurse will ask you to fill out a questionnaire called a health risk assessment. Answering these questions will help you get the most from your yearly wellness visit.

During your visit, the doctor or nurse will:

Go over your health risk assessment with you
Measure your height and weight and check your blood pressure
Ask about your health history and conditions that run in your family
Ask about other doctors you see and any medicines you take
Give advice to help you prevent disease, improve your health, and stay well
Look for any changes in your ability to think, learn, or remember
Ask about any risk factors for substance use disorder and talk with you about treatment options, if needed

If you take opioids to treat pain, the doctor or nurse may talk with you about your risk factors for opioid use disorder, review your treatment plan, and tell you about non-opioid treatment options. They may also refer you to a specialist.

Finally, the doctor or nurse may give you a short, written plan to take home. This plan will include any screening tests and other preventive services that you’ll need in the next several years. Preventive services are health care services that keep you from getting sick.

Learn more about yearly wellness visits .

Plan Your Visit

When can i go for a yearly wellness visit.

You can start getting Medicare wellness visits after you’ve had Medicare Part B for at least 12 months. Keep in mind you’ll need to wait 12 months in between Medicare wellness visits.

Do I need to have a “Welcome to Medicare” visit first?

You don’t need to have a “Welcome to Medicare” preventive visit before getting a yearly wellness visit.

If you choose to get the “Welcome to Medicare” visit during the first 12 months you have Medicare Part B, you’ll have to wait 12 months before you can get your first yearly wellness visit.

Learn more about the “Welcome to Medicare” visit .

What about cost?

With Medicare Part B, you can get a wellness visit once a year at no cost to you. Check to make sure the doctor or nurse accepts Medicare when you schedule your appointment.

If you get any tests or services that aren’t included in the yearly wellness visit (like an extra blood test), you may have to pay some of those costs.

Who Can Get Medicare?

Medicare is a federal health insurance program. You may be able to get Medicare if you:

Are age 65 or older
Are under age 65 and have a disability
Have amyotrophic lateral sclerosis (ALS), also called Lou Gehrig's disease
Have permanent kidney failure (called end-stage renal disease)

You must be living in the United States legally for at least 5 years to qualify for Medicare. Answer these questions to find out when you can sign up for Medicare .

Make an Appointment

Take these steps to help you get the most out of your Medicare yearly wellness visit.

Schedule your Medicare yearly wellness visit.

Call your doctor’s office and ask to schedule your Medicare yearly wellness visit. Make sure it’s been at least 12 months since your last wellness visit.

If you're looking for a new doctor, check out these tips on choosing a doctor you can trust .

To find a doctor who accepts Medicare:

Search for a doctor on the Medicare website
Call 1-800-MEDICARE (1-800-633-4227)
If you use a TTY, call Medicare at 1-877-486-2048

Gather important information.

Take any medical records or information you have to the appointment. Make sure you have important information like:

The name and phone number of a friend or relative to call if there’s an emergency
Dates and results of checkups and screening tests
A list of vaccines (shots) you’ve gotten and the dates you got them
Medicines you take (including over-the-counter medicines and vitamins), how much you take, and why you take them
Phone numbers and addresses of other places you go to for health care, including your pharmacy

Make a list of any important changes in your life or health.

Your doctor or nurse will want to know about any big changes since your last visit. For example, write down things like:

Losing your job
A death in the family
A serious illness or injury
A change in your living situation

Know your family health history.

Your family's health history is an important part of your personal health record. Use this family health history tool to keep track of conditions that run in your family. Take this information to your yearly wellness visit.

Ask Questions

Make a list of questions you want to ask the doctor..

This visit is a great time to ask the doctor or nurse any questions about:

A health condition
Changes in sleeping or eating habits
Pain or discomfort
Prescription medicines, over-the-counter medicines, or supplements

Some important questions include:

Do I need to get any vaccines to protect my health?
How can I get more physical activity?
Am I at a healthy weight?
Do I need to make any changes to my eating habits?

Use this question builder tool to make a list of things to ask your doctor or nurse.

It can be helpful to write down the answers so you remember them later. You may also want to take a friend or relative with you for support — they can take notes, too.

What to Expect

Know what to expect at your visit..

The doctor or nurse will ask you questions about your health and safety, like:

Do you have stairs in your home?
What do you do to stay active?
Have you lost interest in doing things you usually enjoy?
Do you have a hard time hearing people on the phone?
What medicines, vitamins, or supplements do you take regularly?

The doctor or nurse will also do things like:

Measure your height and weight
Check your blood pressure
Ask about your medical and family history

Make a wellness plan with your doctor.

During the yearly wellness visit, the doctor or nurse may give you a short, written plan — like a checklist — to take home with you. This written plan will include a list of preventive services that you’ll need over the next 5 to 10 years.

Your plan may include:

Getting important screenings for cancer or other diseases
Making healthy changes, like getting more physical activity

Follow up after your visit.

During your yearly wellness visit, the doctor or nurse may recommend that you see a specialist or get certain tests. Try to schedule these follow-up appointments before you leave your wellness visit.

If that’s not possible, put a reminder note on your calendar to schedule your follow-up appointments.

Add any new health information to your personal health documents.

Make your next wellness visit easier by updating your medical information in the personal health documents you keep at home. Write down any vaccines you got and the results of any screening tests.

Medicare offers an online tool called MyMedicare to help you track your personal health information and Medicare claims. If you have your Medicare number, you can sign up for your MyMedicare account now .

Healthy Habits

Take care of yourself all year long..

After your visit, follow the plan you made with your doctor or nurse to stay healthy. Your plan may include:

Getting important screenings
Getting vaccines for older adults
Keeping your heart healthy
Preventing type 2 diabetes
Lowering your risk of falling

Your plan could also include:

Getting active
Eating healthy
Quitting smoking
Watching your weight

Content last updated February 9, 2023

Reviewer Information

This information on Medicare wellness visits was adapted from materials from the Centers for Medicare and Medicaid Services

Reviewed by: Rachel Katonak Centers for Medicare and Medicaid Services Division of Policy and Evidence Review Coverage and Analysis Group

November 2022

You may also be interested in:

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Home Doctor Visits: What Does Medicare Cover?

Since the beginning of the Covid-19 pandemic, patients have been hesitant to schedule in-person doctor visits – hence the increase in telehealth and telemedicine services. Yet, there are many conditions, services, and treatments for which virtual appointments are far from ideal.

Medicare beneficiaries may have Covid-related anxieties regarding face-to-face appointments in a medical setting, because of their higher risk. This begs the question: Does Medicare cover home doctor visits?

Types of Medicare Coverage

Before you try to figure out whether Medicare will cover a home doctor visit, you’ll need to know which doctors you can visit with your coverage. When you have Original Medicare (Parts A and B), with or without a Medicare Supplement (Medigap) policy, you’ll have coverage for any practitioner accepting Medicare assignment. Fortunately, most doctors in the United States accept the coverage.

With a Medicare Advantage (Part C) plan, you’ll need to stick to your policy’s network of doctors to receive coverage for any care you receive. Additionally, you’ll require referrals for coverage through your plan when seeing any specialist. Part C includes the coverage Parts A and B provide, which are inpatient and outpatient services, respectively.

When Does Medicare Cover House Calls?

Unfortunately, Medicare doesn’t typically cover the type of house calls with which people are most familiar. Even in the age of Covid, it’s not as simple to make an appointment for a home visit from your primary care physician as it is to schedule a telehealth visit.

Ultimately, Medicare will pay for you to receive care at home ( home health care ) if your circumstances qualify you for such. Again, you’ll need to make sure your provider accepts Medicare assignment (if you have Original Medicare) or is within your Advantage plan’s network for your care to receive coverage. This rule of thumb applies regardless of whether the care will take place at your home.

Medicare’s guidelines for home health care dictate that the visit must be medically necessary. Thus, you must be under the care of a doctor for your condition(s) and your doctor deems certain at-home care to be a necessity.

You must qualify as homebound, meaning you have difficulty leaving your home independently (i.e., without the use of an assistive device, such as a cane). Further, your practitioner must document a face-to-face meeting with you to verify your eligibility.

An eligible individual can receive physical, speech, or occupational therapy, or intermittent care from a skilled nursing professional at home. The practitioner providing the service must accept Medicare assignment or contract with your Advantage plan.

Independence at Home

In 2011, the Centers for Medicare & Medicaid Services (CMS) launched a program called the Independence at Home Demonstration. It is a voluntary, primary care program for patients with multiple chronic conditions who are still living independently but would benefit from a doctor’s visit at home. Yet only an extremely limited number of sites across the country participate in the model.

The program has resulted in savings for CMS. While the program was supposed to end at the close of 2020, it is now extended through the end of 2023 . If further success results from this endeavor, Medicare may see changes regarding this type of care.

The Future of Home Doctor Visits on Medicare

Hesitancy to attend in-person medical appointments due to possible Covid-19 exposure increases the need for alternative options. While Medicare now includes more coverage for telehealth than ever, the same cannot be said for house calls.

When an individual needs a face-to-face appointment with their primary provider to determine necessity for home health care, it’s clear that coverage is far from comprehensive. With the need to fill this gap in coverage and the success of the Independence at Home Demonstration, Medicare will hopefully see more coverage for primary care house calls – including routine check-ups – in the future. The health of beneficiaries depends on it.

How often have you visited your doctor’s office in the past year and a half? How often have you used telehealth services? Would you ask for a home doctor visit if it were available? How would that help you?

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Yes I’d love home Dr visits, im wheelchair dependent and getting out and dressed for the appointment is an all day thing, not to mention wating to be seen is extremely painful.

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Jagger Esch

Jagger Esch is a Medicare expert and the founder, president, and CEO of MedicareFAQ. He has been working in the Medicare space for over 10 years. Jagger has a passion for sharing his expertise on Medicare to beneficiaries so they can be better prepared for health care costs after retirement. His YouTube channel features various videos that help Medicare beneficiaries discover all their options.

All About Medicare Part D – Prescription Drug Coverage

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Common questions about Medicare annual wellness visits

If you are a Medicare recipient, you can take advantage of annual wellness visits. These visits are a preventive health benefit available after having Medicare Part B coverage for at least one year. All Medicare Advantage Plans are required to offer annual wellness visits for their members. A nurse or nurse practitioner reviews your health status and helps you plan for health and wellness needs.

In most cases, the annual wellness visit will be followed by a separate medical visit with your primary care professional to close any health care gaps and address any problems identified during the visit.

Here are answers to common questions about annual wellness visits.

Why are annual wellness visits important.

The annual wellness visit allows you to review your health history and identify any current or potential health risks with a health care professional. The visit enables the nurse to focus on prevention and wellness while making sure you are current on recommended immunizations and health screenings like colonoscopies or mammograms. It also allows your primary care professional more time to focus on your medical concerns and needs at a separate physical exam.

Do I need to be 65 or older to have an annual wellness visit?

You do not need to be 65 or older to qualify for an annual wellness visit as long as you've been on Medicare Part B for at least one year.

How is an annual wellness visit scheduled?

If you are due for an annual wellness visit, you may be prompted to self-schedule the visit in the patient portal . You also may call your care team and ask to be scheduled.

If your visit is with a nurse or nurse practitioner, it's recommended to schedule this visit before the visit with your primary care professional. This allows your primary care professional the chance to address any concerns mentioned during your annual wellness visit.

How can I prepare for my annual wellness visit?

You may be asked to complete some questionnaires before arriving for your appointment, which will be sent to your patient portal account. If you cannot access the questionnaires before the appointment, plan to arrive at your appointment early to complete them.

It's helpful to come prepared to your visit with this information:

All medications, vitamins and supplements you take, including how much and how often you take them
Additional medical records, including immunization records
Dates of your most recent preventive services, like a colonoscopy or mammogram, if completed by another health care facility
Family health history, with as much detail as possible
List of medical providers and suppliers who provide you care, equipment or services

What can you expect during an annual wellness visit?

During the visit, you'll meet with a nurse or nurse practitioner to:.

Evaluate your fall risk
Measure your height, weight and blood pressure
Offer referrals to other health education or preventive services
Provide information related to voluntary advance care planning
Screen for cognitive impairments like dementia
Screen for depression
Update your medical and family history

What is the cost of an annual wellness visit?

Medicare offers the visit at no cost for people who have Medicare Part B coverage for at least one year before the visit. If you are referred for other tests or services, they will be billed to your insurance. If you have a separate visit with your primary care professional following your annual wellness visit, you or your insurance carrier will be responsible for the cost of that visit.

Robert Stroebel, M.D. , is a Community Internal Medicine, Geriatric and Palliative Care physician at Mayo Clinic Primary Care in Rochester and Kasson, Minnesota.

Types of Doctors and Medical Specialists: Which One Should You See?

Learn about the different types of primary care doctors and medical specialists.

This article is based on reporting that features expert sources.

Types of Medical Specialists

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Navigating the health care system is daunting, especially when determining which type of doctors or medical specialists to see for specific health concerns. Understanding the role of your primary care physician and various medical specialists will help you make informed decisions about your health care needs.

Learn about the different types of medical specialists and when you may need a referral to visit a specialty doctor.

Key Takeaways

There are various types of primary care doctors, including internal medicine doctors, family medicine doctors and pediatricians.
Primary care physicians can generally take care of a majority of medical cases.
You may need to see a specialist in certain circumstances, such as if you have a chronic or complex disease, lab results that need expert interpretation, an uncertain diagnosis or a need or want for a second opinion.
There are various medical specialists and subspecialists who are specifically trained in the diagnosis and treatment of certain types of diseases and conditions.

Primary Care Doctors

Primary care doctors are the entry point to the medical system. They provide a comprehensive approach to care, including prevention, treatment and rehabilitation of health issues. Primary care doctors also help coordinate care when you need to see a specialist.

Having a primary care doctor allows for an ongoing patient-doctor relationship built on mutual trust.

There are different types of primary care doctors :

Internal medicine doctors. Also called an internist , internal medicine doctors manage common and complex illnesses typically for adults and older adults.
Family medicine doctors. Family medicine doctors provide continuous care for people of all ages, backgrounds and conditions, often caring for entire families from birth through the end of life.
Pediatricians. Pediatricians are a type of primary care doctor specializing in the care of infants, children and adolescents. They provide primary and preventive care, including administering routine immunizations or providing acute care for common childhood illnesses , like ear infections, colds and flu and minor injuries.

Starting with a visit to your primary care physician is a great way to assess whether or not you need to see a specialist.

“Sometimes, I’ll say to the patient, ‘I can take care of that. You don’t need to go to the specialist at this point in time,’” says Dr. Theodore Strange, chair of medicine at Staten Island University Hospital, a division of Northwell Health, in New York City.

In fact, upwards of 95% of cases can be taken care of with good primary care , says Dr. David Cutler, a board-certified family medicine physician at Providence Saint John’s Health Center in Santa Monica, California. “The referral itself is the exception,” he adds.

When to See a Medical Specialist

However, there are a few reasons doctors may refer patients to a specialist, including:

If the patient has a certain chronic or complex disease with symptoms that may need specialist testing. For example, someone with a cardiac condition may need a stress test, or an individual with a GI condition may need a specific type of endoscopy or colonoscopy.
If you have the results of testing and need a more expert interpretation of the test to better treat the case.
If there’s a patient with an uncertain diagnosis. A primary care physician may refer you to a specialist if they have run out of options and need an expert with more specialized medical knowledge to diagnose and treat you.
If you need or want a second opinion .

Types of Medical Specialists You Might Need

Medical specialists have additional training and expertise in a specific area of medicine. Some even subspecialize, meaning they have even more specialized training within their specific field of medicine.

Below are several common medical specialists you might see.

Allergists-immunologist

What is an allergist-immunologist? An allergist-immunologist diagnoses, treats and manages disorders related to the immune system, immune deficiency diseases and adverse reactions to triggers, such as drugs or food.

What do allergists-immunologists treat? Allergist-immunologists treat allergic rhinitis (hay fever), food allergies , asthma, eczema, immunodeficiency disorders and other conditions related to the immune system.

Cardiologist

What is a cardiologist? Cardiologists deal with the prevention and treatment of disorders of the heart and vascular system.

What do cardiologists treat? Cardiologists treat cardiac issues, such as coronary artery disease , heart failure, arrhythmias and congenital heart defects.

Dermatologist

What is a dermatologist? Dermatologists are medical specialists trained in the diagnosis and management of conditions related to the skin, hair and nails.

What do dermatologists treat? Dermatologists treat a wide range of issues, including acne, rashes, eczema, psoriasis , skin infections and skin cancer . They may also treat patients with cosmetic concerns, such as wrinkles or acne scarring.

Endocrinologist

What is an endocrinologist? Endocrinologists are doctors who focus on disorders related to the endocrine system , which involves the glands and organs that make hormones.
What do endocrinologists treat? Endocrinologists treat patients with endocrine conditions and disorders, such as diabetes, thyroid disorders, metabolic abnormalities and hormonal imbalances .

Gastroenterologist

What is a gastroenterologist? Gastroenterologists , or GI doctors, manage diseases of the gastrointestinal tract, including your esophagus, stomach, bowels, liver, pancreas and gallbladder.

What do gastroenterologists treat? Gastroenterologists treat GI conditions, like cancer , hepatitis, irritable bowel syndrome, diarrhea or constipation, heartburn and ulcers.

Geriatric medicine specialist

What is a geriatric medicine specialist? Also referred to as geriatricians , specialty doctors of geriatric medicine have specialized knowledge related to aging and training in diagnostic, therapeutic, preventive and rehabilitative care for older adults.
What do geriatric medicine specialists treat? Geriatric physicians treat conditions that may commonly occur with aging , such as cognitive decline, mobility issues, chronic diseases and medication management. They often collaborate with other health care professionals, such as physical and occupational therapists, mental health professionals and social workers.

Hematologist

What is a hematologist? Hematologists focus on disorders related to the blood and blood-forming tissues and organs.

What do hematologists treat? Hematologists treat blood-related conditions, such as anemia , bleeding or clotting disorders and blood cancers.

Hospice and palliative medicine specialist

What is a hospice and palliative medicine specialist? Hospice and palliative medicine specialists provide care and support to patients and their families as the patient navigates living with a serious or terminal illness.
What do hospice and palliative medicine specialists treat? Hospice and palliative medicine specialists aim to prevent and alleviate suffering and to focus on improving quality of life for those with serious illness. This may include addressing physical, psychological, social and spiritual needs, such as administering pain management or end-of-life care . Common conditions treated include cancer, cardiovascular diseases and chronic obstructive pulmonary diseases, or COPD .

Infectious disease specialist

What is an infectious disease specialist? Infectious disease specialists diagnose and treat infections caused by bacteria, viruses, fungi or parasites.
What do infectious disease specialists treat? This medical specialist treats a wide range of infectious diseases, including HIV/AIDS , antibiotic-resistant infections and tuberculosis.
What is a geneticist? These medical specialists diagnose and treat genetic disorders or conditions. Geneticists have special training in the study of genes and heredity.
What do geneticists treat? Clinical geneticists care for patients in a clinical or research-based setting, and many geneticists counsel patients at risk for particular genetic disorders or cancers, such as sickle cell disease or hereditary breast and ovarian cancer .

Nephrologist

What is a nephrologist? Nephrologists are medical doctors who treat disorders of the kidney.

What do nephrologists treat? Nephrologists treat patients with kidney-related disorders , including kidney stones, chronic kidney disease and kidney failure. They often provide related medical management and may oversee dialysis, kidney transplantation and postoperative care, and managing diabetes or high blood pressure .

Neurologist

What is a neurologist? Neurologists are specialty doctors who diagnose and treat disorders of the nervous system, including the brain, spinal cord and nerves.

What do neurologists treat? Neurologists treat a range of disorders affecting the nervous system, including epilepsy, stroke, Alzheimer’s disease and other memory disorders , Parkinson’s disease and migraines.

Obstetrician-gynecologist

What is an OB-GYN? An obstetrician-gynecologist specializes in the medical and surgical care of women related to pregnancy and childbirth and disorders of the female reproductive system.

What do OB-GYNs treat? In addition to pregnancy and childbirth, OB-GYNs specialize in women’s health issues, such as menopause , contraception (birth control), infertility, endometriosis and polycystic ovarian syndrome, or PCOS.

What is an oncologist? Oncologists specialize in diagnosing and treating cancer .

What do oncologists treat? Oncologists manage several aspects of cancer care throughout the course of the disease and often consult with other specialists, like surgical oncologists, to develop treatment plans and provide care. These medical doctors often subspecialize in a particular type of cancer, such as breast oncology , neuro-oncology and radiation oncologists.

Ophthalmologist

What is an ophthalmologist? Ophthalmologists are eye doctors who are medically trained to manage all aspects of eye and vision care , including medical and surgical treatments.

What do ophthalmologists treat? General ophthalmologists treat diseases and disorders of the eye, such as cataracts, glaucoma, eye infections, diabetic retinopathy and refractive errors. They can also prescribe glasses and contact lenses.

Orthopedist

What is an orthopedist? A general orthopedist , or orthopedic surgeon , specializes in disorders and injuries of the musculoskeletal system, including bones, joints, ligaments, tendons and muscles.

What do orthopedists treat? Orthopedists may treat congenital deformities, traumatic or sports injuries, spinal disorders and degenerative diseases, as well as perform other types of orthopedic surgery .

Otolaryngologist

What is an otolaryngologist? Commonly referred to as ear, nose and throat doctors, or ENTs, otolaryngologists are medical and surgical specialty doctors who diagnose and treat diseases and disorders of the head and neck.

What do otolaryngologists treat? Conditions ENTs treat may include chronic sinusitis, allergic or non-allergic rhinitis, gastrointestinal reflux , tonsillitis and sleep apnea .

Physical medicine and rehabilitation physician

What is a physical medicine and rehabilitation physician? Also referred to as physiatrists , these doctors focus on the functioning of the whole patient, rather than specific organs or systems, to manage pain and restore function.
What do physical medicine and rehabilitation physicians treat? Physiatrists treat conditions which may limit a person’s ability to function, such as amputation, brain injury, cerebral palsy, Parkinson’s disease or a spinal cord injury.

Plastic surgeon

What is a plastic surgeon? Plastic surgeons subspecialize in performing procedures that restore, reconstruct or replace physical defects or functions.
What do plastic surgeons treat? Plastic surgeons handle reconstructive procedures, like cleft lip and palate repair or breast reconstruction after mastectomy, as well as cosmetic procedures, such as rhinoplasty or facelift.
What is a podiatrist? Podiatrists treat issues of the foot, ankle and lower extremities.
What do podiatrists treat? Podiatrists manage conditions or injuries related to the lower extremities, such as sprains and fractures, plantar fasciitis , bunions, hammertoes and foot and ankle arthritis.

Psychiatrist

What is a psychiatrist? A psychiatrist is a medical doctor who specializes in the evaluation and treatment of mental health, emotional and behavioral health disorders. They can prescribe medication and use other medical approaches to disease.
What do psychiatrists treat? Psychiatrists see patients with mental, addictive and emotional disorders, such as psychotic disorders, mood disorders, anxiety disorders and substance use disorders.

Psychologist

What is a psychologist? A psychologist is a mental health professional who treats mental, emotional and behavioral issues through therapy and counseling. Unlike psychiatrists, they cannot prescribe medication in most states. (Only Idaho, Illinois, Iowa, Louisiana and New Mexico allow psychologists with additional, specialized training to prescribe from an approved list of medications for certain emotional and mental health disorders, but they often collaborate with psychiatrists and other health providers.)
What do psychologists treat? Similar to psychiatrists, psychologists work with patients with a variety of mental health disorders . They may also see people without clinical disorders who are feeling stressed or anxious to help them cope more effectively.

Pulmonologist

What is a pulmonologist? Pulmonologists are medical specialists of the respiratory system.

What do pulmonologists treat? Pulmonologists manage serious or chronic diseases of the lungs and airways, such as emphysema, bronchitis , pneumonia, asthma and COPD.

Rheumatologist

What is a rheumatologist? Rheumatologists are specialized medical doctors who diagnose and treat disorders related to your joints, muscles and connective tissues.

What do rheumatologists treat? Rheumatologists treat musculoskeletal diseases and systemic autoimmune conditions – referred to as rheumatic diseases – such as rheumatoid arthritis , osteoarthritis, lupus, fibromyalgia and gout .

Sleep medicine specialist

What is a sleep medicine specialist? These medical specialists manage clinical sleep-related disorders and promote healthy sleeping habits.

What do sleep medicine specialists treat? Sleep medicine specialists use clinical assessment and physiologic testing to diagnose, manage and prevent sleep disorders , such as insomnia, narcolepsy, parasomnias, circadian rhythm disorders and sleep-related breathing disorders, like obstructive sleep apnea.

General surgeon

What is a general surgeon? General surgeons are trained in diagnosis, preoperative, operative and postoperative management in the nine primary components of surgery, which consist of the:

Abdominal and pelvic organs.
Breasts, skin and soft tissues.
Head and neck.
Cardiovascular system.
Endocrine system.
Surgical oncology.
Critical care and emergency surgery.

What do general surgeons treat? General surgeons can perform surgical procedures for a wide range of conditions, including appendectomies, hernia repairs and gallbladder removals.

What is a urologist? Urologists are doctors who deal with diseases of the male reproductive organs and the male and female urinary tract.

What do urologists treat? Urologists may treat kidney stones , urinary incontinence and erectile dysfunction .

Do You Need a Referral to See Specialists?

Whether or not you need a referral to see a specialist depends on your health insurance plan , your doctor or the type of specialist you’re trying to see.

Point of service, or POS, plans and health maintenance organizations, or HMOs, often require a primary care physician to work with your insurer for pre-approval to visit a specialist. The referral also likely needs to be for a specialist within your insurance network. If you’re unsure whether or not you need a referral, check with your insurance company first. Otherwise, your plan may not cover the care and you’ll get stuck with high out-of-pocket costs.

In addition to the patient’s health insurance coverage, symptoms , medical history and diagnostic testing and results, primary care physicians will likely take these factors into consideration when making a referral:

Accessibility . It's important for the specialist to be geographically accessible to the patient.
Availability . Some specialists can take months to make an appointment with, so referring doctors take their availability into consideration.
Coordination of care . When physicians are part of a broader health network, they’ll likely recommend a specialized doctor within the same network. One benefit is shared electronic medical records, which helps streamline follow-up coordination of care.

Patient preferences or needs . Doctors may discuss options with a patient, taking their particular values, personal preferences or individual needs into account to ensure the referral aligns with their goals.

The U.S. News Health team delivers accurate information about health, nutrition and fitness, as well as in-depth medical condition guides. All of our stories rely on multiple, independent sources and experts in the field, such as medical doctors and licensed nutritionists. To learn more about how we keep our content accurate and trustworthy, read our editorial guidelines .

Cutler is a board-certified family medicine physician at Providence Saint John’s Health Center in Santa Monica, California.

Strange is the chair of medicine at Staten Island University Hospital, a division of Northwell Health, in New York City.

Tags: women's health , men's health , children's health , senior health , health care , family health , doctors , patient advice

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Why You Should Not Expect Medicare to Cover a Physical Exam

When you enroll in Medicare, it is natural to think they would cover a physical exam. Unfortunately, you would be out of luck if you expect them to pay for it. They will not pay for a physical checkup of the kind you are probably expecting.

Medicare does cover a lot of medical services. When Medicare was created, the documents that declared its services stated that they cannot cover a complete physical exam.

The Welcome to Medicare Checkup

Your medical history and your family’s medical history.
Get some basic measurements: your body mass index, height, weight, and blood pressure.
Talk about any risk factors that might reveal the presence of a serious illness.
Find out about your stability and ability to function normally (will look for your ability to make decisions, handle finances, signs of dementia, etc.).
Give a simple vision test.
See if depression is present or if there is a risk for it.
Check your prescriptions and look for opioids and possible substance abuse.
Recommend screenings and various preventive services.
Find out if the individual has an advance directive in place or a living will—and discuss them if the individual wants to know more.

A Physical Exam Contains More

a check of your vital signs
a discussion of health issues
a look at your prescriptions
a physical exam
questions about your daily activities, relationships, and your environment at home

With Medicare, You Must Pay for a Complete Physical If You Want One

Medigap coverage, medicare advantage plans.

Long-Term Care Coverage

some services given by a chiropractor or acupuncturist not considered medically necessary
routine foot care
cosmetic surgery
alternative or experimental medicine
most over-the-counter drugs
medical services needed outside the United States

Medicare requires that Wellness visits be 365 days apart. If you have an opportunity to get a Wellness visit, see if you can schedule a physical appointment at the same time, but be prepared to pay for it—or at least part of it.

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Will Your Healthcare Costs Be More Than You Planned for in Retirement?

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IMAGES

Medicare Wellness Visit: What To Expect?
Does Medicare Cover Doctor Visits? A Comprehensive Guide
Medicare Hospice Coverage
Make the Most of Your Annual Medicare Wellness Visit
What Is An Annual Wellness Visit For Medicare?
How to Get More Out of the Medicare Annual Wellness Visit

COMMENTS

Doctor Services Coverage
Medicare Part B (Medical Insurance) covers. medically necessary. doctor services (including outpatient services and some doctor services you get when you're a hospital inpatient) and most preventive services. If you haven't received services from your doctor or group practice in the last 3 years, they may consider you a new patient.
When does Medicare cover doctor visits?
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 ...
When Does Medicare Cover Doctors Visits?
Although doctors visits are covered by Medicare, there are still costs for beneficiaries. First, program enrollees must meet the annual deductible before Medicare makes any payment for medically necessary services. This means that you must pay a certain amount on medical bills each year before coverage begins. In 2024, the annual deductible was ...
Will Medicare Cover the Costs of My Doctor Visits?
Let's say the Medicare-approved costs were $100 for the doctor visit and $900 for the MRI. Assuming that you've paid your Part B deductible, and that Part B covered 80% of these services, you'd still be left with some costs. In this scenario, you'd typically pay $20 for the doctor visit and $180 for the x-rays.
Does Medicare cover doctor visits?
Medicare Part B covers your doctor visits, durable medical equipment, and medical services you receive in outpatient settings. 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 doctor ...
Does Medicare Cover Doctor Visits?
You do not need referrals from a primary doctor in order to see a specialist. You can visit any specialist that accepts assignment, as well. You will likely pay 20% of the Medicare approved amount and the Part B deductible may apply. If you choose to enroll in a Medicare Advantage plan, you will have at least the same Part A and Part B benefits ...
Does Medicare Cover Doctor Visits? Here's What's Included
Yes, Medicare covers doctor's visits if they're medically necessary. If you have Original Medicare, visits are covered by your Part B insurance. Costs can vary depending on the type of visit and whether or not your doctor accepts the Medicare-approved amount for payment. Knowing what Medicare does and doesn't cover before your next visit ...
Medicare Doctor Coverage: What Does Medicare Part B Cover?
Medicare Part B is the outpatient medical insurance portion of Original Medicare. It helps pay for preventative services as well as medically necessary outpatient services such as doctors visits, physical therapy, ambulance services, and more. Medicare Part B also provides coverage for durable medical equipment such as wheelchairs, walkers ...
Medicare Preventive Services: What's Covered
Cardiovascular disease screening, covered every five years, along with one behavior therapy visit a year to talk about lowering your cardiovascular disease risk with your physician. Depression screening, once a year. Diabetes screening, up to twice a year for people at high risk of diabetes. Flu shots.
How to Get Your Telehealth Appointment Covered by Medicare
These visits are often done to determine whether you need an office visit, and you don't need to be an established patient. In addition, Medicare covers e-visits, during which you communicate with your doctor or other provider (nurse practitioner, social worker or physical therapist, for instance) via an online patient portal.
Get Your Medicare Wellness Visit Every Year
Schedule your Medicare yearly wellness visit. Call your doctor's office and ask to schedule your Medicare yearly wellness visit. Make sure it's been at least 12 months since your last wellness visit. If you're looking for a new doctor, check out these tips on choosing a doctor you can trust. To find a doctor who accepts Medicare: Search for ...
Medicare Part B: Doctor Costs and Lab Tests
But if you have a higher than average personal income (over $97,000) or household income (over $194,000), you will have to pay a higher monthly premium for Medicare Part B. The monthly adjustment ...
Home Doctor Visits: What Does Medicare Cover?
In 2011, the Centers for Medicare & Medicaid Services (CMS) launched a program called the Independence at Home Demonstration. It is a voluntary, primary care program for patients with multiple chronic conditions who are still living independently but would benefit from a doctor's visit at home. Yet only an extremely limited number of sites ...
Medicare Part B: Costs, Eligibility and What It Covers
The Centers for Medicare & Medicaid Services announced that the standard monthly Part B premium will be $174.70 in 2024, an increase of $9.80 from $164.90 in 2023. Premiums start rising as income ...
Medicare annual wellness visits FAQ
All Medicare Advantage Plans are required to offer annual wellness visits for their members. A nurse or nurse practitioner reviews your health status and helps you plan for health and wellness needs. In most cases, the annual wellness visit will be followed by a separate medical visit with your primary care professional to close any health care ...
Medicare Vision Coverage: What's Included and What's Not
These are your doctor's appointments, urgent care clinic visits, tests, blood tests, and supplies that are medically necessary to diagnose or treat your condition. Part B also covers preventive ...
Types of Doctors and Medical Specialists: Which One Should You See?
Family medicine doctors. Family medicine doctors provide continuous care for people of all ages, backgrounds and conditions, often caring for entire families from birth through the end of life ...
Did You Know? Medicare Does Not Cover A Physical Exam
Medicare offers a second preventive visit; this one is every 12 months. It may be annual, but this visit is also not a physical exam. The purpose is to update the personalized prevention plan.
Medicare.gov
Find doctors & clinicians near me. Find general information about doctors, clinicians and groups enrolled in Medicare. Find Medicare-approved providers near you & compare care quality for nursing homes, doctors, hospitals, hospice centers, more. Official Medicare site.
Why You Should Not Expect Medicare to Cover a Physical Exam
Medicare will cover the cost of a Wellness visit, which you can get every year. ... If the doctor accepts Medicare, a Wellness visit will not cost you anything, but you must have Medicare Part B ...
When Does Medicare Cover Doctors Visits?
Medicare covers 80% of the costs doctors visits for medically necessary treatment after you met your Part B deductible. Some preventive services, such as annual wellness visits, may be covered fully by Part B. For both Original Medicare and Medicare Advantage beneficiaries, doctor choice can be limited. People in Original Medicare must visit a ...

Does Medicare cover doctor visits?

What parts of Medicare cover doctor visits?

Medicare Part B

Medicare Part C (Medicare Advantage plans)

Medicare resources

When does Medicare not cover doctor visits?

How much does Medicare pay for a doctor visit?

A note on insurance

How we reviewed this article:

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Does Medicare cover doctor visits?

Does Medicare cover doctor visits ?

Which parts of Medicare cover doctor visits ?

What’s not covered?

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How many doctor visits does Medicare cover?

How much do doctor visits cost with Medicare?

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Table of Contents

What Types of Doctor Visits and Outpatient Services Does Medicare Cover?

Preventative Services

Medical Services

Specialist Visits

What Kinds of Doctor Visits Does Medicare Not Cover?

Wellness Visits

How Medicare Covers Your Visits to the Doctor

How Medigap Coverage Helps

How Medicare Advantage Covers Your Visits to the Doctor

Medicare Coverage of Telehealth

Medicare Coverage of Doctor-prescribed Medication

What Are Your Options If Medicare Does Not Cover a Doctor You Need?

Ask for a Referral to Another Provider

Pay the Costs Out of Pocket

Switch to a Medicare Advantage Plan

What This Means For You

You’re just a few steps away from seeing your Medicare Advantage plan options.

Medicare Preventive Services: What's Covered

Learn More About Medicare

What doctor visits does Medicare cover?

Your Welcome to Medicare visit

A Medicare preventive care visit

A Medicare annual Wellness visit

Medicare doesn’t cover routine physical exams

Does Medicare cover free tests and screenings?

Medicare Advantage vs. Original Medicare

Compare plans today.

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Getting Your Telehealth Appointments Covered by Medicare

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Get Your Medicare Wellness Visit Every Year

Take Action

What happens during a yearly wellness visit?

Plan Your Visit

Do I need to have a “Welcome to Medicare” visit first?

What about cost?

Who Can Get Medicare?

Make an Appointment

Schedule your Medicare yearly wellness visit.

Gather important information.

Make a list of any important changes in your life or health.

Know your family health history.

Ask Questions

What to Expect

Make a wellness plan with your doctor.

Follow up after your visit.

Add any new health information to your personal health documents.