Yes, Medicare Part B has a deductible you pay before coverage starts
Medicare Part B covers doctor visits, outpatient care, and medical equipment. Before Medicare pays for most of these services, you must first pay an annual deductible out of your own pocket. Once you meet that deductible in a calendar year, Medicare then covers a percentage of the cost, and you pay a copay or coinsurance for the rest.
The deductible amount changes each year. It is set by Medicare and announced in the fall for the following year. After you pay the deductible once in January through December, it resets on January 1 and you start over.
Not every Part B service requires you to meet the deductible first. Some preventive services — like annual wellness visits and certain screenings — are covered at no cost to you, even before you hit the deductible. But most doctor visits and tests do count toward it.
Key Takeaways
- You pay a yearly deductible before Medicare Part B coverage begins, and this amount resets every January 1.
- Preventive services like wellness visits and cancer screenings do not require you to meet the deductible first.
- After you meet the deductible, you typically pay 20 percent coinsurance for doctor visits and outpatient services, while Medicare covers 80 percent.
- The deductible amount is announced each fall and varies year to year based on Medicare's cost projections.
- If you have a Medigap or Medicare Advantage plan, your out-of-pocket costs may be lower because those plans can cover the deductible.
How much is the Part B deductible and when does it reset
The Part B deductible is a fixed dollar amount you must pay for covered services before Medicare begins to share the cost. The exact amount changes annually. To find the current year's deductible, check your Medicare Summary Notice (the letter Medicare sends you each year), call Medicare at 1-800-MEDICARE, or visit Medicare.gov.
The deductible applies to the calendar year only — January 1 through December 31. If you meet it in March, you do not carry any remaining balance into April. On January 1, the counter resets to zero, and you start fresh with a new deductible to meet. This means if you have major medical expenses late in the year, you may end up paying two deductibles in a short span (one before year-end and another after January 1).
Which Part B services require you to pay the deductible
Most doctor visits and outpatient services count toward your deductible. This includes visits to your primary care doctor, specialists, urgent care centers, and hospital outpatient departments. Lab work, X-rays, and other diagnostic tests also require you to meet the deductible first.
However, certain preventive services are exempt from the deductible requirement. These include your annual wellness visit, cancer screenings (mammograms, colonoscopies, Pap smears), cardiovascular screenings, diabetes screenings, bone density tests, and some vaccinations. Medicare covers these at no cost to you, regardless of whether you have met your deductible for the year.
Durable medical equipment — like wheelchairs, walkers, and oxygen equipment — also counts toward the deductible. Once you meet it, you typically pay 20 percent coinsurance for the equipment.
What you pay after meeting the deductible
Once you have paid your annual deductible, Medicare does not cover 100 percent of your bills. For most Part B services, Medicare covers 80 percent and you pay 20 percent coinsurance. This coinsurance applies to doctor visits, specialist visits, tests, and outpatient procedures.
The 20 percent coinsurance has no annual cap under Original Medicare. This means if you have expensive ongoing treatment or multiple specialist visits, your coinsurance costs can add up significantly throughout the year. Some people purchase a Medigap policy specifically to cover this coinsurance gap.
For certain services like mental health visits, the rules differ slightly. Outpatient mental health services are covered at 80 percent after the deductible, but some settings (like community mental health centers) may have different cost-sharing rules. Always ask your provider what you will owe before your visit.
How Medigap and Medicare Advantage plans affect your deductible
If you have Original Medicare alone, you are responsible for paying the full Part B deductible yourself. But if you have a Medigap (supplemental insurance) plan or a Medicare Advantage plan, your out-of-pocket costs may be much lower.
Medigap plans are sold by private insurance companies and are designed to cover costs that Original Medicare does not — including the Part B deductible. Depending on which Medigap plan you choose (Plan A, Plan B, Plan G, and so on), the plan may pay your deductible for you, meaning you pay nothing out of pocket before Medicare coverage kicks in. You still pay a monthly premium for the Medigap plan, but you avoid the deductible hit.
Medicare Advantage plans (Part C) are an alternative to Original Medicare. These plans are offered by private insurers and often have lower or no deductibles than Original Medicare. However, they typically have other cost-sharing features, like copays for doctor visits or networks you must use. The trade-off is lower upfront costs but potentially higher costs if you use out-of-network providers.
Strategies to manage your Part B deductible and coinsurance
If you know you will have significant medical expenses, consider timing elective procedures or appointments. Scheduling a major test or procedure early in the year means you meet your deductible sooner and benefit from Medicare's 80 percent coverage for the rest of the year. Conversely, if you have already met your deductible late in the year, you may want to schedule preventive care or routine visits before January 1 to avoid paying another deductible when ready.
Keep track of what you have paid toward your deductible. Your Medicare Summary Notice shows how much of your deductible you have met. If you see your doctor or have tests done, ask the provider's billing office to confirm whether the service counts toward your deductible and what your out-of-pocket cost will be. This prevents surprises when the bill arrives.
If cost is a concern, ask your doctor about lower-cost alternatives or whether a test is truly necessary. Some imaging or lab work can be deferred or done at a lower cost at a different facility. Your doctor's office can also tell you which services are preventive (and thus free) versus diagnostic (and thus subject to the deductible).
Frequently Asked Questions
Do I have to pay the Part B deductible every year?
Yes. The deductible resets on January 1 each year, so you must meet it again in the new calendar year. If you have Part B coverage throughout the year, you will encounter the deductible annually unless you have a Medigap plan that covers it for you.
What happens if I do not meet my deductible by the end of the year?
If you do not use enough Part B services to reach your deductible by December 31, the unused portion does not roll over. The deductible resets to zero on January 1, and any amount you did not use is lost. You start fresh with a new deductible to meet.
Are preventive services really free, or do I still pay something?
Preventive services covered by Medicare Part B are free — you pay nothing, even if you have not met your deductible. This includes wellness visits, screenings, and certain vaccinations. However, if your visit includes a non-preventive service (like treating a chronic condition), that portion may be subject to the deductible and coinsurance.
If I have a Medicare Advantage plan, do I still have a Part B deductible?
Medicare Advantage plans set their own deductibles and cost-sharing rules. You may have a lower deductible, no deductible, or a different structure altogether. Check your plan documents or call your plan to learn your specific deductible and what services it applies to.
Can my doctor's office tell me in advance what I will owe for a visit?
Yes. Call your doctor's billing office before your appointment and ask whether the visit counts toward your deductible, what your coinsurance will be, and what your total out-of-pocket cost is likely to be. Provide them with your Medicare information so they can look up your deductible status.