Yes, Medicare Part B has a deductible you pay before coverage begins

Medicare Part B covers doctor visits, outpatient care, and medical equipment. Before Medicare pays for most of these services, you have to pay a yearly deductible out of your own pocket. Once you meet that deductible, you then pay a percentage of the cost (called coinsurance) for most services for the rest of the year.

The deductible amount changes each year. In 2024, the Part B deductible is $240. This means you pay the first $240 of your Part B services yourself before Medicare starts to help pay. After you reach $240, Medicare typically covers 80 percent of approved charges, and you pay the remaining 20 percent.

Key Takeaways

  • Medicare Part B has a yearly deductible of $240 in 2024, which resets on January 1 each year.
  • Once you meet the deductible, Medicare covers 80 percent of most services and you pay 20 percent coinsurance for the rest of the year.
  • The deductible applies to doctor visits, lab tests, imaging, and durable medical equipment, but not to preventive services like screenings and vaccines.
  • If you have a Medigap or Medicare Advantage plan, that plan may pay some or all of your deductible and coinsurance costs.
  • The deductible amount increases most years, so check your Medicare notices in the fall to see what you will owe in the coming year.

What services require you to pay the Part B deductible

The deductible applies to most doctor visits and outpatient services. This includes visits to your primary care doctor or a specialist, lab work, X-rays, CT scans, and other diagnostic tests. It also covers durable medical equipment like wheelchairs, walkers, and oxygen supplies.

However, some services do not count toward your deductible. Preventive care — such as annual wellness visits, cancer screenings, flu shots, and pneumonia vaccines — is covered at no cost to you. Mental health visits and therapy also do not require you to pay the deductible first. Once you understand which services are covered preventively, you can plan which visits might count toward your deductible.

How the deductible and coinsurance work together

Think of the deductible as a threshold you cross once per year. If you see your doctor in January and the visit costs $150, you pay the full $150 toward your $240 deductible. If you have lab work done in February that costs $100, you pay that $100 as well. Once those two visits total $240, your deductible is met.

After you meet the deductible, Medicare covers 80 percent of the approved amount for most services, and you pay 20 percent. So if you have another doctor visit in March that costs $100, Medicare pays $80 and you pay $20. This 20 percent coinsurance continues for the rest of the calendar year, even if you have many more visits.

The deductible resets on January 1 each year, meaning you start over at zero on the first day of the new year. If you have services in December, those do not carry over to count toward next year's deductible.

How supplemental insurance affects what you owe

If you have a Medigap policy (also called Medigap or supplemental insurance), that plan may pay your Part B deductible and coinsurance for you. Some Medigap plans cover the full deductible; others cover part of it. The specific coverage depends on which Medigap plan you choose. When you enroll in a Medigap plan, you receive a summary that shows what it covers.

If you have a Medicare Advantage plan instead of Original Medicare, the rules are different. Medicare Advantage plans set their own deductibles, which may be higher, lower, or the same as the Part B deductible. Some Medicare Advantage plans have no deductible at all. You should review your plan's documents to see what deductible and coinsurance you will owe.

When the deductible amount changes

Medicare updates the Part B deductible each year based on inflation and other factors. The new amount takes effect on January 1. In recent years, the deductible has increased most years, though the amount of increase varies.

You will receive a notice from Medicare in the fall (usually October or November) that tells you the new deductible for the coming year. This notice also lists any other changes to your coverage. If you receive Social Security, you may see this information in your Social Security statement as well. Checking this notice helps you plan for the costs you may face in the new year.

How to track your deductible progress

You can see how much of your deductible you have used by logging into your Medicare account at Medicare.gov. Once you sign in with your username and password, you can view your claims and see how much you have paid toward your deductible so far in the year.

You can also call Medicare directly at 1-800-MEDICARE (1-800-633-4227) to ask how much of your deductible remains. Have your Medicare card handy when you call. Your doctor's office or the facility where you receive care may also be able to tell you how much you have paid toward your deductible, though they may need a few days to update their records after you receive a service.

Frequently Asked Questions

Do I have to pay the Part B deductible for preventive care?

No. Preventive services like wellness visits, cancer screenings, vaccinations, and some blood tests are covered at no cost to you and do not count toward your deductible. However, if your doctor finds a problem during a preventive visit and you need follow-up care, that follow-up care may require you to pay the deductible.

What happens if I do not use my full deductible by the end of the year?

The deductible does not roll over. On January 1, your deductible resets to zero, and you start fresh. Any amount you did not use in the previous year is lost. This is why some people try to schedule needed services before the year ends if they are close to meeting their deductible.

Does the Part B deductible explore to emergency room visits?

Yes, the Part B deductible applies to emergency room visits and the services you receive there. However, if you are admitted to the hospital as an inpatient, you would then owe the Part A deductible instead, which is separate and usually higher than the Part B deductible.

Can my doctor's office bill me more than the deductible and coinsurance?

If your doctor accepts Medicare, they can only bill you for the deductible and coinsurance on the Medicare-approved amount. They cannot charge you extra. However, if your doctor does not accept Medicare, different rules may explore, so ask before your visit.