What a Medicare deductible is and when you pay it

A deductible is the amount of money you have to pay out of your own pocket for healthcare services before Medicare starts to pay its share. Once you reach your deductible for the year, Medicare begins covering a portion of your costs — but you may still owe copayments or coinsurance after that point.

The deductible amount and when it applies depends on which part of Medicare you have. Part A (hospital insurance) has one deductible. Part B (medical insurance) has a different deductible. Part D (prescription drug coverage) has its own deductible. If you have a Medicare Advantage plan instead of Original Medicare, your plan sets its own deductible, which may be lower or higher than the standard amounts.

Deductibles reset every January 1st, so any amount you paid toward your deductible in December does not carry over to the next year.

Key Takeaways

  • Part A has a deductible that applies per hospital stay, not per year — you pay it each time you are admitted to the hospital.
  • Part B has an annual deductible that you pay once per calendar year before Medicare covers doctor visits and outpatient services.
  • Part D deductibles vary by plan and can range from zero to several hundred dollars per year.
  • Medicare Advantage plans set their own deductibles, which may be lower than Original Medicare but often come with network restrictions.
  • Once you meet your deductible, you still pay coinsurance or copayments — the deductible is not your total out-of-pocket cost for the year.

Part A deductible: hospital stays and skilled nursing

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 once per year. This means if you are admitted to the hospital, discharged, and then admitted again later in the same year, you pay the deductible twice.

The deductible amount changes each year. For 2024, the Part A deductible is $1,632 per hospital stay. You pay this amount before Medicare covers any of your hospital costs. After you meet the deductible, Medicare covers most of your inpatient hospital care for the first 60 days of each stay.

If your hospital stay extends beyond 60 days, you then owe a daily coinsurance amount for days 61 through 90, and a higher daily amount for days 91 and beyond. This is separate from the deductible — it kicks in after Medicare has already started paying.

Part B deductible: doctor visits and outpatient care

Part B covers doctor visits, outpatient services, diagnostic tests, and medical equipment. The Part B deductible is an annual amount you pay once per calendar year. For 2024, the Part B deductible is $240. Once you have paid $240 out of pocket for covered Part B services, Medicare begins to pay its share.

After you meet the deductible, you typically pay 20 percent coinsurance for most Part B services, and Medicare pays 80 percent. Some services, like preventive care, may have no coinsurance — Medicare covers them fully once the deductible is met.

The Part B deductible applies to services from any doctor or provider who accepts Medicare, whether you see them in an office, a clinic, or an outpatient hospital setting. It does not explore to Part A services like hospital stays.

Part D deductible: prescription drugs

Part D covers prescription medications through a standalone plan (if you have Original Medicare) or through your Medicare Advantage plan. Each Part D plan sets its own deductible, which can range from zero to several hundred dollars per year. Some plans have no deductible at all.

Once you reach your plan's deductible, you move into the next coverage phase, where you pay a copayment or coinsurance for each prescription. The exact amount depends on your plan's formulary — the list of covered drugs and their cost-sharing tiers.

Part D also has a coverage gap (sometimes called the "donut hole"), which is a range of drug costs where you pay a higher percentage of the cost. This is separate from the deductible and occurs after you and your plan have spent a certain amount on drugs together.

Medicare Advantage deductibles and how they differ

If you have a Medicare Advantage plan (Part C), the plan itself sets the deductible amounts and structure. Some Medicare Advantage plans have no deductible, while others have deductibles similar to or higher than Original Medicare. A few plans may have separate deductibles for different types of care — for example, a lower deductible for primary care visits and a higher one for specialist visits.

Medicare Advantage plans must cover everything that Original Medicare covers, but they can organize the costs differently. Many plans use copayments instead of coinsurance, which means you pay a fixed dollar amount per visit rather than a percentage of the cost. This can make it easier to predict your out-of-pocket expenses.

The trade-off is that Medicare Advantage plans usually require you to use doctors and hospitals within their network. Using an out-of-network provider typically costs you more or may not be covered at all.

What happens after you meet your deductible

Meeting your deductible does not mean Medicare covers everything from that point forward. After you pay your deductible, you enter a cost-sharing phase where you and Medicare split the cost of your care.

For Part B services, you typically pay 20 percent coinsurance and Medicare pays 80 percent. For Part A hospital stays beyond 60 days, you pay a daily coinsurance amount. For Part D drugs, you pay a copayment or coinsurance based on your plan's tier system.

Original Medicare also has an annual out-of-pocket maximum for Part B services. Once you have paid a certain amount in deductibles and coinsurance combined, Medicare covers 100 percent of your Part B costs for the rest of that year. This maximum changes each year and provides a cap on your total spending.

How to track your deductible throughout the year

Your Medicare Summary Notice (MSN) shows what you have paid toward your deductible and what Medicare has paid on your behalf. You receive an MSN every three months if you have Original Medicare and have had any claims processed. Review it to see how much of your deductible you have met so far.

If you have a Medicare Advantage or Part D plan, your plan sends you a statement showing your deductible progress. You can also log into your plan's website or call the plan's customer service number to check your deductible status at any time.

Keeping track helps you understand how much more you need to spend before Medicare begins to pay, and it lets you catch any billing errors early. If you see a charge you do not recognize or believe is incorrect, contact your provider or plan to ask for an explanation.

Frequently Asked Questions

Do I have to pay both a Part A and Part B deductible?

Yes. Part A and Part B are separate, so they have separate deductibles. You pay the Part A deductible when you are admitted to the hospital, and you pay the Part B deductible for doctor visits and outpatient care. They do not count toward each other.

What if I switch Medicare plans mid-year?

If you switch to a new Original Medicare plan, your deductible does not reset — you continue paying toward the same annual deductible. If you switch to a Medicare Advantage plan, the new plan's deductible applies, and any amount you paid toward your old plan's deductible does not transfer.

Does my deductible cover preventive services?

No. Medicare covers many preventive services — like annual wellness visits, cancer screenings, and vaccinations — at no cost to you, even before you meet your deductible. These services are covered in full by Medicare.

Can I use my Health Savings Account to pay my Medicare deductible?

Once you enroll in Medicare, you cannot contribute new money to a Health Savings Account. However, you can use money already in the account to pay Medicare premiums, deductibles, and coinsurance. You cannot use it for over-the-counter medications.

What if I cannot afford to pay my deductible?

If your income is low, you may be may be able to access for programs like Medicaid or the Medicare Savings Program, which can help pay your deductibles and premiums. Contact your state Medicaid office or call 1-800-MEDICARE to learn about programs in your area.