What You Pay Out of Pocket: Medicare Deductibles Explained

Medicare has four separate deductibles, and they change every year

Medicare is not one insurance plan — it is four, and each one has its own deductible. Part A (hospital care) has a deductible you pay once per benefit period. Part B (doctor visits and outpatient care) has a yearly deductible. Part D (prescription drugs) has a yearly deductible. Part C (Medicare Advantage) deductibles vary by plan. The amounts change on January 1 each year, so what you paid last year will not be what you pay this year.

The deductible is the amount you must pay out of your own pocket before Medicare starts to pay. Once you meet the deductible, you typically pay a copay or coinsurance for each service. If you have both Part A and Part B, you will have two separate deductibles to meet in the same year.

Key Takeaways

Part A has a deductible per benefit period (not per year), which resets when you have been out of the hospital for 60 days in a row.
Part B has a yearly deductible that resets January 1, and you must meet it before Medicare covers doctor visits or lab work.
Part D deductibles explore to prescription drugs only and vary by plan, ranging from zero to several hundred dollars.
Medicare Advantage (Part C) plans set their own deductibles, which may be lower or higher than Original Medicare, and some plans have no deductible.
Deductible amounts are set by federal law and change every January; you can find the current year's amounts on Medicare.gov or your plan documents.

Part A deductible: hospital stays and skilled nursing

Part A covers inpatient hospital stays, skilled nursing facility care, and hospice. The deductible applies once per benefit period, not once per year. A benefit period starts the day you enter the hospital and ends 60 days after you leave. If you go back into the hospital more than 60 days later, a new benefit period begins and you owe the deductible again.

The Part A deductible covers your first day in the hospital. After you pay it, Medicare covers all hospital costs for days 1 through 60 of your stay. On days 61 through 90, you pay a daily coinsurance amount. If you stay longer than 90 days, you have 60 additional "lifetime reserve days" you can use, and you pay a higher daily coinsurance for those.

Part A also covers the first 20 days of skilled nursing facility care with no cost to you after you meet the deductible. Days 21 through 100 require a daily coinsurance payment. After day 100, you pay the full cost.

Part B deductible: doctor visits and outpatient services

Part B covers doctor visits, lab work, X-rays, ambulance services, and most outpatient care. You must meet the Part B deductible before Medicare pays for any of these services. The deductible resets every January 1, regardless of when you enrolled in Part B.

Once you meet the deductible, you typically pay 20 percent coinsurance for most services, and Medicare pays 80 percent. Some services, like preventive care (annual wellness visits, cancer screenings, vaccines), have no coinsurance — Medicare covers them fully after you meet the deductible. Other services, like mental health visits, may have different cost-sharing rules.

If you see multiple doctors or have multiple services in the same year, the costs add up toward your deductible. Once any combination of Part B services reaches the deductible amount, the deductible is met for the rest of that calendar year.

Part D deductible: 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 to several hundred dollars per year. Some plans have no deductible at all. The deductible resets every January 1.

The deductible applies to most drugs, but not all. Plans must cover certain drugs without a deductible, including vaccines, cancer drugs, and some other medications. Once you meet the deductible, you move into the "initial coverage" phase, where you pay a copay or coinsurance for each prescription.

Part D also has a coverage gap (sometimes called the "donut hole"), where you pay a higher percentage of drug costs after you and your plan have spent a certain amount. The gap ends when your total out-of-pocket spending reaches a yearly limit, after which Medicare covers most drug costs for the rest of the year.

Medicare Advantage (Part C) deductibles

Medicare Advantage plans are sold by private insurance companies and must cover everything Original Medicare covers, but they set their own deductibles and cost-sharing rules. Some plans have no deductible. Others have a deductible that applies to all services, or separate deductibles for different types of care (one for hospital, one for doctor visits, one for drugs).

Medicare Advantage plans often have lower deductibles than Original Medicare, but they may have higher copays or coinsurance. They also typically include prescription drug coverage built in, so you do not need a separate Part D plan. The deductible and cost-sharing details are in your plan's Summary of Benefits and Coverage document, which you receive when you enroll.

How deductibles interact with other costs

If you have Original Medicare (Parts A and B), you have two separate deductibles. Meeting the Part A deductible does not count toward Part B, and vice versa. You must pay both in full unless you have supplemental insurance (Medigap) that helps cover them.

If you have a Medigap plan, it may pay your deductibles, coinsurance, and copays after you meet them. Some Medigap plans cover the Part B deductible entirely, so you do not owe it. Others cover it partially. Your Medigap plan documents will show exactly what costs it covers.

If you have Medicare Advantage, the deductible and cost-sharing are built into that single plan. You do not have separate Part A and Part B deductibles. However, you may have a separate deductible for prescription drugs within the same plan.

Where to find the current deductible amounts

Deductible amounts are published by the Centers for Medicare and Medicaid Services (CMS) every October for the following year. You can find them on Medicare.gov under "Costs at a Glance" or in your plan's official documents. Your insurance company or plan provider must send you a notice of any changes to your deductible by October 15 each year.

If you are enrolled in a specific plan, your plan documents (the Summary of Benefits and Coverage or Evidence of Coverage) will show your exact deductible. If you are comparing plans, the Medicare Plan Finder tool on Medicare.gov lets you enter your prescriptions and see the deductible and total estimated costs for each plan in your area.

Frequently Asked Questions

Do I have to pay my deductible every year?

Yes. Part B and Part D deductibles reset every January 1. Part A deductibles reset when you have been out of the hospital for 60 days in a row. If you do not use hospital services, you will not owe a Part A deductible that year, but you will still owe Part B if you see a doctor.

What happens if I switch Medicare plans mid-year?

If you switch from Original Medicare to Medicare Advantage, any deductible you already paid toward Part B does not transfer to your new plan. You may have to meet a new deductible with the Medicare Advantage plan. If you switch between Medicare Advantage plans, the same applies — deductibles do not carry over.

Can Medigap or Medicare Advantage plans cover my deductible?

Some Medigap plans cover your Part A and Part B deductibles fully or partially. Medicare Advantage plans set their own deductibles, which are often lower than Original Medicare. Check your plan documents to see what deductibles and cost-sharing your plan covers.

Does my Part A deductible cover both hospital and skilled nursing care?

Yes. The Part A deductible covers your first day in the hospital and also applies to skilled nursing facility care if you go there after a hospital stay. You pay the deductible once per benefit period, not separately for each type of care.

What if I cannot afford to pay my deductible?

If you have limited income, you may be may be able to access for Medicare Savings Programs or Extra Help with prescription drug costs. These programs can help pay your deductibles and other out-of-pocket costs. Contact your state Medicaid office or call 1-800-MEDICARE to learn whether you may have access to.

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.