What You Pay Out of Pocket: Medicare's Deductibles Explained

Yes, Medicare has deductibles, and they vary by part

Medicare Part A (hospital insurance) and Part B (medical insurance) both have deductibles you pay before Medicare starts to cover costs. Part D (prescription drug coverage) also has a deductible. The amounts change each year, and they are different for each part. If you have Original Medicare, you will encounter these costs when you use hospital care, doctor visits, or fill prescriptions.

The deductible is the amount you must pay out of your own pocket before your Medicare coverage kicks in. Once you meet the deductible for that part, Medicare begins to pay its share of covered services. However, meeting the deductible in one part does not count toward the deductible in another part — Part A, Part B, and Part D each have separate deductibles.

Key Takeaways

Part A has a deductible that applies per hospital stay, not per year, and covers inpatient hospital care.
Part B has an annual deductible you pay once per calendar year before Medicare covers doctor visits and outpatient services.
Part D (prescription drug plans) has an annual deductible that varies by plan, and you pay it before the plan covers most medications.
If you have a Medigap or Medicare Advantage plan instead of Original Medicare, your deductibles and out-of-pocket costs work differently and may be lower.
Deductible amounts are set by Medicare and increase most years, so check your plan documents or Medicare.gov each January to learn the current year's amounts.

Part A deductible: what it covers and when you pay it

Part A covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health services. The Part A deductible applies per hospital stay, not per year. This means if you are admitted to the hospital, discharged, and then admitted again later in the same year, you will owe the deductible twice — once for each separate stay.

You pay the Part A deductible when you are admitted to the hospital. The hospital bills Medicare, and you are responsible for the deductible amount before Medicare's coverage begins. If you stay longer than a certain number of days, you may also owe coinsurance (a daily cost-sharing amount) for days beyond what Medicare covers fully.

Part B deductible: annual cost before doctor visits are covered

Part B covers doctor visits, outpatient care, diagnostic tests, and medical equipment. The Part B deductible is an annual amount, meaning you pay it once per calendar year (January through December). Once you have paid the deductible, Medicare covers its share of Part B services for the rest of that year.

You pay the Part B deductible to your doctor's office or the provider who bills you. After you meet it, you typically pay a copayment (a fixed amount per visit) or coinsurance (a percentage of the cost) for each service, and Medicare pays the rest. The deductible resets on January 1st each year.

Part D deductible: prescription drug coverage

Part D is prescription drug coverage offered through private insurance companies approved by Medicare. Most Part D plans have an annual deductible, though some plans have no deductible. The deductible amount varies depending on which plan you choose, and you pay it before the plan covers most of your medications.

Once you meet the Part D deductible, you move into the initial coverage phase, where you and the plan share the cost of medications. The plan covers a percentage of the cost, and you pay a copayment or coinsurance. Part D deductibles reset on January 1st each year.

How Medigap and Medicare Advantage plans change your deductibles

If you have Original Medicare plus a Medigap (supplemental insurance) plan, the Medigap plan may pay some or all of your Medicare deductibles, depending on which Medigap plan you choose. Some Medigap plans cover the Part A deductible, the Part B deductible, or both. This can significantly reduce your out-of-pocket costs.

Medicare Advantage plans (Part C) are an alternative to Original Medicare. These plans are offered by private insurance companies and typically have lower or no deductibles than Original Medicare, but they may have higher copayments or coinsurance. Medicare Advantage plans also include Part D prescription drug coverage built in, so you do not purchase Part D separately. The deductible structure in a Medicare Advantage plan depends on the specific plan you choose.

Finding your current deductible amounts

The easiest way to find your deductible amounts is to check your Medicare Summary Notice, which Medicare mails to you once a year. You can also log into your account on Medicare.gov and view your coverage details. If you have a Medigap or Medicare Advantage plan, your plan documents or your plan's website will show your deductibles and cost-sharing amounts.

Deductible amounts change on January 1st each year. If you want to know the amounts for the upcoming year before January arrives, you can visit Medicare.gov in the fall, where Medicare publishes the new amounts. You can also call Medicare at 1-800-MEDICARE (1-800-633-4227) to ask about current deductible amounts.

When to ask your doctor or plan about deductibles

Before a scheduled procedure or test, ask your doctor's office whether the service is covered by Medicare and whether you have already met your Part B deductible for the year. If you have not met it, you will owe the deductible amount. For prescriptions, ask your pharmacist or call your Part D plan to find out whether you have met your drug plan deductible and what you will pay for a specific medication.

If you are unsure whether a service is covered or how much you will owe, contact your plan directly. Medicare Advantage plans and Medigap plans have customer service numbers on your insurance card. For Original Medicare questions, call 1-800-MEDICARE.

Frequently Asked Questions

Do I have to pay my Part A deductible if I am admitted to the hospital through the emergency room?

Yes. The Part A deductible applies to any inpatient hospital admission, whether you arrive through the emergency room or are admitted from your doctor's office. You owe the deductible once per hospital stay, regardless of how you entered the hospital.

If I meet my Part B deductible in June, do I have to pay it again in July?

No. Once you have paid your Part B deductible in a calendar year, you do not pay it again until January 1st of the next year. After you meet the deductible, you continue to pay copayments or coinsurance for Part B services for the rest of the year, but not the deductible.

What happens if I switch from Original Medicare to a Medicare Advantage plan mid-year?

If you switch plans during the year, any deductible you have already paid toward Original Medicare does not carry over to your new plan. Your new plan has its own deductible, and you may owe it again depending on the plan and the time of year you switch. Review your new plan's documents to understand what you will owe.

Can I use my Health Savings Account (HSA) to pay Medicare deductibles?

Yes, if you have an HSA, you can use those funds to pay Medicare deductibles and other out-of-pocket costs. However, you cannot have an HSA if you are enrolled in Medicare, so this applies only if you are still working and have not yet enrolled in Medicare.

Are there any Medicare services with no deductible?

Yes. Some preventive services under Part B, such as annual wellness visits, certain screenings, and vaccinations, are covered with no deductible. However, you still pay the Part B deductible for most other doctor visits and services. Ask your doctor whether a specific service is considered preventive and covered without a deductible.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.