What Medicare Part B Covers
Medicare Part B covers two main categories:
Medically necessary services:
- Doctor visits (primary care and specialists)
- Outpatient hospital services
- Emergency care
- Mental health services (outpatient)
- Physical and occupational therapy
- Durable medical equipment (wheelchairs, walkers, oxygen)
- Lab tests and X-rays
- Ambulance services
- Chemotherapy and radiation (outpatient)
- Dialysis
Preventive services (often $0 cost):
- Annual wellness visit
- Cardiovascular disease screenings
- Diabetes screenings and supplies
- Cancer screenings (mammograms, colonoscopy, lung CT)
- Flu, pneumonia, and COVID-19 vaccines
- Glaucoma tests (for high-risk patients)
What Part B Does NOT Cover
Part B does not cover:
- Routine dental care (cleanings, fillings, dentures)
- Routine vision care (glasses, contacts)
- Hearing aids and exams for fitting hearing aids
- Cosmetic surgery
- Prescription drugs (covered under Part D)
- Long-term custodial care (nursing home care for activities of daily living)
- Podiatry for routine foot care (covered for certain conditions only)
- Acupuncture (except for chronic low back pain under specific conditions)
The Part B 20% Problem
After your Part B deductible ($257 in 2026), Medicare pays 80% of approved costs. You're responsible for the remaining 20% — with no annual out-of-pocket cap.
This is the biggest financial risk of Original Medicare. A serious illness — cancer treatment, major surgery, cardiac care — can cost tens of thousands in 20% coinsurance. A $100,000 outpatient chemotherapy course leaves you with $20,000 in Part B coinsurance.
Medigap Plan G eliminates this 20% entirely. After your $257 deductible, Plan G pays 100% of Part B coinsurance regardless of how much care you need. This unlimited protection is the core value of Medigap.
Part B Excess Charges: A Florida-Specific Concern
Doctors who don't 'accept assignment' can charge up to 15% more than Medicare's approved rate — these are called Part B excess charges. While most Florida doctors accept Medicare assignment, some — particularly certain specialists in South Florida — do not.
Plan G covers Part B excess charges in full. Plan N does not. If you see specialists who may charge excess amounts, Plan G's coverage is a meaningful protection. Verify whether your Florida doctors accept assignment at medicare.gov/care-compare.