How Much Does Medicare Part B Pay for Physician Fees?
If you’re enrolled in Medicare or planning ahead, it’s important to understand how much Medicare Part B pays for physician fees and outpatient services. Medicare Part B helps cover many medical costs, but it doesn’t pay 100%. So, how much can you expect Medicare to cover when you see a doctor?
In this article, we’ll break down:
- What Medicare Part B covers
- How much it pays for physician fees and doctors visits
- What your out-of-pocket costs may be
- Tips to reduce your medical expenses
What Does Medicare Part B Cover?
Medicare Part B covers outpatient medical care. This includes services like:
- Doctor visits and physician fees (primary and specialists)
- Preventive care (such as flu shots and cancer screenings)
- Lab tests and X-rays
- Mental health outpatient care
- Some home health services
- Durable medical equipment (like walkers or oxygen)
To get Medicare Part B, you must pay a monthly premium (in 2025, the standard premium is around $174.70) and meet an annual deductible.
How Much Does Medicare Pay for Physician Fees?
Medicare Part B uses something called the Medicare Physician Fee Schedule (MPFS) to determine how much it pays for each medical service. This is a standardized list of fees Medicare will approve for covered services.
Once your deductible is met, Medicare generally pays 80% of the approved amount. That leaves Medicare beneficiaries with the remaining 20% of the cost.
But this only applies if your doctor accepts Medicare assignment, meaning they agree to the Medicare-approved amount as full payment.
What If Your Doctor Doesn’t Accept Medicare Assignment?
There are two types of Medicare providers:
- Participating providers: Accept Medicare assignment and cannot charge more than the approved amount.
- Non-participating providers: May charge up to 15% more than the Medicare-approved rate. This is called the limiting charge.
If your doctor doesn’t accept assignment, you could be responsible for up to 35% of the total bill (20% coinsurance + 15% excess charge).
💡 Tip: Always ask your provider if they accept Medicare before receiving care.
How to Reduce Your Out-of-Pocket Costs
Medicare Part B doesn’t cover everything—but you have options to lower your costs.
1. Enroll in a Medicare Supplement Plan (Medigap). Medigap plans help pay for Part B coinsurance and other out-of-pocket expenses. These plans are offered by private insurers and work alongside Original Medicare.
2. Consider a Medicare Advantage Plan. Medicare Advantage (Part C) plans often include physician coverage with predictable copays and lower out-of-pocket maximums. However, they usually require staying within a provider network.
3. Apply for Financial Assistance. Programs like Medicaid, Extra Help, or state Medicare Savings Programs may help low-income beneficiaries pay premiums and coinsurance.
Bottom Line: What You Need to Know
Medicare Part B typically pays 80% of the cost for physician services, leaving you to cover the other 20%. Understanding whether your doctor accepts Medicare, and knowing your coverage options, can help you manage healthcare costs more confidently.
Ready to Maximize Your Medicare Coverage?
If you’re unsure how to make your healthcare more affordable, give us a call. We’re in the business of saving you as much money as possible on healthcare costs. Get a free health and plan consultation to ensure you’re in the best coverage option available.
