Medicare has different deductibles for each part, and they change every year

Medicare is not one plan with one deductible. Part A (hospital insurance), Part B (medical insurance), and Part D (prescription drugs) each have their own deductible — the amount you pay before Medicare starts to pay. The deductible amounts are set by federal law and increase each January 1st based on healthcare costs from the previous year.

If you have a Medigap or Medicare Advantage plan, your deductibles may be different from Original Medicare, and some plans cover the deductible entirely. This means what you actually pay depends on which type of Medicare coverage you have.

Key Takeaways

  • Part A has a deductible per hospital stay (not per year), and it covers inpatient hospital, skilled nursing, and hospice care.
  • Part B has an annual deductible 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 often have lower or zero deductibles but may limit which doctors and hospitals you can use.
  • Your actual out-of-pocket costs depend on whether you have Original Medicare, Medigap, or Medicare Advantage.

Part A deductible: what you pay for hospital stays

Part A covers inpatient hospital care, skilled nursing facility care after a hospital stay, and hospice. The deductible applies per benefit period, not per year. A benefit period begins the day you enter the hospital and ends 60 days after you leave without receiving any inpatient hospital or skilled nursing care.

If you go back into the hospital more than 60 days after leaving, a new benefit period starts and you pay the deductible again. This means you could pay the deductible more than once in a calendar year if you have multiple hospital stays separated by at least 60 days.

After you pay the Part A deductible, Medicare covers your hospital stay in full for days 1 through 60. On days 61 through 90, you pay a daily coinsurance amount (a set dollar amount per day, not a percentage). Beyond day 90, costs rise further, and Medicare's coverage becomes limited.

Part B deductible: what you pay for doctor visits and outpatient care

Part B covers doctor visits, outpatient services, medical equipment, and preventive care. The deductible is an annual amount — you pay it once per calendar year (January through December), and then Medicare begins to pay its share of covered services.

Once you meet the Part B deductible, you typically pay 20% of the Medicare-approved amount for most services, and Medicare pays 80%. Some preventive services (like annual wellness visits and certain screenings) are covered at no cost after you meet the deductible.

The Part B deductible is separate from Part A. You must meet both deductibles in the same year if you use both hospital and outpatient services.

Part D deductible: what you pay for prescription drugs

Part D is prescription drug coverage offered through private insurance companies approved by Medicare. Each plan sets its own deductible, which can range from zero dollars to a maximum amount set by federal law. Some plans have no deductible at all.

After you pay your plan's deductible, you move into a phase where you and your plan share the cost of drugs (called the "initial coverage phase"). The exact amounts you pay depend on your plan and the drug's tier — generic drugs usually cost less than brand-name drugs.

Part D deductibles reset every January 1st. If you switch plans during the annual enrollment period (October 15 through December 7), your new plan's deductible begins on January 1st of the following year.

How Medigap plans change what you pay

Medigap (supplemental insurance) is sold by private insurers and is designed to cover costs that Original Medicare does not — including deductibles, coinsurance, and copayments. If you have Medigap Plan G or Plan F, for example, the plan pays your Part B deductible after you meet it, so you do not pay it twice.

Different Medigap plans cover different amounts. Some plans cover the Part A deductible entirely; others require you to pay part of it. You choose which Medigap plan to buy, and the plan's coverage determines what you actually pay out of pocket.

Medigap does not cover Part D drugs. You must enroll in a separate Part D plan if you want prescription drug coverage.

How Medicare Advantage plans change what you pay

Medicare Advantage (Part C) is an alternative to Original Medicare, offered by private insurance companies. These plans often have lower or zero deductibles, but they work differently: instead of paying a percentage of costs after the deductible, you typically pay a copayment for each service (a fixed dollar amount like $25 for a doctor visit).

Medicare Advantage plans must cover everything Original Medicare covers, but they can organize it differently and may require you to use doctors and hospitals within their network. Some plans cover Part D drugs as part of the plan; others require a separate Part D enrollment.

Because Medicare Advantage plans vary widely, comparing deductibles and copayments between plans is essential during the annual enrollment period.

When deductibles reset and how to track them

Part A and Part B deductibles reset on January 1st each year. Part D deductibles also reset on January 1st. If you have a Medicare Advantage plan, copayments and deductibles reset on January 1st as well.

Keep track of what you have paid toward your deductible throughout the year. Your Medicare Summary Notice (sent quarterly) shows how much you have paid toward Part A and Part B deductibles. Your Part D plan sends an Explanation of Benefits (EOB) showing your drug deductible progress. If you have Medicare Advantage, your plan's EOB tracks your copayments and deductible.

If you enroll in Medicare mid-year (for example, turning 65 in June), your deductible for that year is prorated — you pay a portion of the full deductible based on how many months remain in the year.

Questions to ask your doctor or Medicare

Before scheduling a service, ask your doctor's office whether the service is covered by Medicare and whether you have already met your deductible for the year. If you are unsure about your coverage, call Medicare directly at 1-800-MEDICARE (1-800-633-4227) or log into your account at Medicare.gov.

If you have a Medigap or Medicare Advantage plan, contact your plan's customer service number (on your insurance card) to confirm what you will pay for a specific service. Plans can cover the same service differently depending on where you receive it.

Frequently Asked Questions

Do I have to pay both a Part A and Part B deductible in the same year?

Yes. Part A and Part B deductibles are separate. If you use both hospital care and outpatient services in the same calendar year, you must meet both deductibles. However, if you have Medigap, your plan may cover one or both deductibles depending on which plan you chose.

What happens if I do not meet my deductible before the year ends?

If you do not use enough services to reach your deductible by December 31st, the unused amount does not carry over to the next year. Your deductible resets to the new amount on January 1st. This is why some people delay elective procedures until after January 1st if they have already met their deductible late in the year.

Can my deductible change mid-year?

No. Your deductible for the year is set on January 1st and does not change until the following January 1st, even if you switch plans. If you enroll in a new plan during the year, the new plan's deductible applies starting the day your coverage begins, but the old plan's deductible does not carry over.

Is there a maximum out-of-pocket cost in Original Medicare?

Original Medicare does not have an annual out-of-pocket maximum like employer health plans do. You could pay unlimited amounts if you have high medical costs. This is one reason many people buy Medigap coverage. Medicare Advantage plans do have out-of-pocket maximums, after which the plan covers 100% of in-network costs for the rest of the year.

Do preventive services count toward my deductible?

No. Many preventive services (like annual wellness visits, cancer screenings, and vaccines) are covered at no cost under Part B, even before you meet your deductible. However, if a preventive visit leads to additional testing or treatment, those services may require you to pay after meeting your deductible.