Often when we feel a little sick but think that we do not need hospitalization, we make an appointment with a doctor to find out what is wrong with us. Though it is more convenient and costs less than hospitalization, setting up an appointment with our doctor is still not cheap. Especially if we are only experiencing light to mild symptoms.
So a common question many people have is, “does Medicare cover doctor’s visits?” In this article, we answer that question in clear, plain English. You will also find the average costs of appointments with the doctor and other helpful info.
Does Medicare Cover Doctor’s Visits?
The short answer is yes. Medicare will cover the cost of visits to the doctor. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your doctor’s visit. Below we look at what these are so you know what to expect.
Original Medicare (Medicare Part A and Part B) provides coverage for doctor’s visits. Coverage for appointments with the doctor is provided by Medicare Part B. Medicare Part B provides coverage for medically necessary outpatient treatments, preventive services, durable medical equipment and supplies, and many more that are medically necessary.
Medicare Part services B will provide coverage for your appointment with your doctor if it is considered medically necessary. Your doctor must also be a medical doctor (MD) or an osteopathic doctor (DO), as well as enrolled in Medicare for Medicare Part B to provide coverage.
However, medically necessary and preventive services provided by the following healthcare providers are also covered by Medicare:
- Occupational Therapists
- Physical Therapists
- Speech-Language Pathologists
- Clinical Psychologists, Social Workers, and Nurse Specialists
- Nurse Practitioners
- Physician Assistants
However, Medicare Part B will not cover doctor’s appointments all the time. In some cases, Medicare Part B will not consider a doctor’s appointment as medically necessary, such as for the following appointments:
- Podiatrist appointment for routine services such as removal of corn and calluses or toenail trimming
- Optometrist appointment for changing prescription eyeglasses
- Dental services appointment for routine dental care
- Naturopathic doctor appointment
- Chiropractic doctor appointment
Once approved by Medicare Part B, they will cover 80 percent of the costs of your doctor’s appointment. You will pay for the remaining 20 percent.
Part C Coverage for Doctor’s Visits
Medicare Advantage plans (Medicare Part C) also provide coverage for doctor’s visits. They cover everything Original Medicare covers, as well as some additional benefits. However, exactly what it covers and your out-of-pocket costs will vary depending on the specifics of your plan.
Many Medicare Part C plans also cover doctor’s appointments and services that are not covered by Medicare Part B, such as appointments with:
- An optometrist for routine vision care
- A dentist for routine dental care
- A naturopathic doctor
- A chiropractic doctor
How Much Does It Cost To Have An Appointment With A Doctor?
The average cost of a doctor’s appointment is estimated between $300 to $600. However, the exact cost will differ depending on what type of service you need as well as the type of doctor.
Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.
Additional Info on Medicare Coverage
This article is part of our series on “What does Medicare cover?”
Also, you can check out other articles in this series including: Does Medicare cover Covid testing?