A Medicare deductible is the amount you pay out of your own pocket before Medicare starts to pay its share

Each part of Medicare has its own deductible. Part A (hospital insurance) has a deductible you pay once per benefit period if you're admitted to the hospital. Part B (medical insurance) has an annual deductible you pay before Medicare covers doctor visits, tests, and outpatient care. Part D (prescription drugs) has an annual deductible before your drug plan begins to pay. The amounts change each year, and they vary depending on which plan you choose.

Once you meet your deductible, you don't stop paying — you move into a different payment structure where Medicare and you share the cost. Understanding which deductible applies to which service, and when it resets, helps you plan for medical expenses throughout the year.

Key Takeaways

  • Part A has a per-benefit-period deductible (not annual), Part B has an annual deductible, and Part D has an annual deductible, and the amounts are different for each.
  • After you meet a deductible, you typically pay a copay or coinsurance for each service, not the full cost.
  • Deductibles reset on January 1 each year for Part B and Part D, but Part A resets when a new hospital stay begins after 60 days without inpatient care.
  • If you have a Medigap or Medicare Advantage plan, the deductible structure may be lower or work differently than Original Medicare.
  • Knowing your deductible amount before the year starts helps you budget for routine care and plan for larger medical expenses.

How Part A deductibles work in a hospital stay

Part A covers inpatient hospital care, skilled nursing facility care, hospice, and some home health services. When you're admitted to a hospital, you pay a deductible for each benefit period. A benefit period starts the day you enter the hospital and ends 60 days after you leave without returning for inpatient care. If you go back into the hospital within 60 days, you don't pay a new deductible — you're still in the same benefit period.

The Part A deductible covers your first day in the hospital. After you pay it, Medicare covers the full cost of hospital care for days 1 through 60 of your stay. Days 61 through 90 require a daily coinsurance payment from you. If your hospital stay goes beyond 90 days, you have access to lifetime reserve days, but those also carry a daily coinsurance cost. Most hospital stays end well before day 60, so many people pay the deductible and then Medicare covers the rest.

How Part B deductibles work for doctor and outpatient care

Part B covers doctor visits, outpatient surgery, diagnostic tests, physical therapy, and durable medical equipment. You pay an annual deductible before Medicare starts to pay. Once you meet it in a calendar year, Medicare covers its share of most Part B services for the rest of that year. The deductible resets on January 1.

After you meet your Part B deductible, you typically pay 20 percent coinsurance for most services, and Medicare pays 80 percent. For some preventive services like annual wellness visits and cancer screenings, Medicare covers the full cost with no coinsurance, even before you meet your deductible. This means you might see a doctor for a preventive visit, pay nothing, and that visit doesn't count toward your deductible.

How Part D deductibles work 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 to a maximum amount set by Medicare each year. Some plans have no deductible at all. Once you meet your plan's deductible, you move into a different cost-sharing phase where you pay a copay or coinsurance for each prescription.

The Part D deductible resets on January 1 each year. If you switch to a different Part D plan during the annual enrollment period, your new plan's deductible starts fresh in January, even if you hadn't met your old plan's deductible. Some people choose plans with higher deductibles but lower monthly premiums, while others pick plans with no deductible but higher premiums — the right choice depends on how many prescriptions you take and which drugs you use.

Deductibles in Medicare Advantage and Medigap plans

If you have a Medicare Advantage plan (Part C), the plan replaces Original Medicare and sets its own deductible structure. Some Advantage plans have no deductible, while others have one that's lower or higher than Original Medicare. The deductible typically applies to all covered services combined, not separately to hospital and doctor visits. Advantage plans must cover everything Original Medicare covers, but they can structure the costs differently.

Medigap (supplemental insurance) works alongside Original Medicare and is designed to cover costs Medicare doesn't pay, including deductibles. If you have a Medigap plan, it may pay your Part A and Part B deductibles for you, depending on which Medigap plan you choose. This means you could have little or no out-of-pocket deductible cost, though you pay a monthly premium for the Medigap coverage. Medigap does not cover Part D deductibles — you need a separate Part D plan for that.

Planning your budget around deductibles

To budget for deductibles, start by finding out the exact amounts for your coverage. You can find Part A and Part B deductible amounts on Medicare.gov, or call Medicare at 1-800-MEDICARE. For Part D, log into your plan's website or call the plan directly — each plan's deductible is different. Write down the amounts and note when they reset (January 1 for Part B and Part D, and when a new hospital benefit period begins for Part A).

If you know you'll need medical care early in the year — a scheduled surgery, regular prescriptions, or ongoing doctor visits — you might want to plan for meeting your deductible in the first few months. If you're healthy and rarely see a doctor, you may never meet your Part B deductible in a given year, which means you'll only pay the deductible if you happen to have a hospital stay. Tracking which services you've used and how much you've paid toward your deductible helps you understand what Medicare will cover next.

Frequently Asked Questions

Do I have to pay my deductible every year?

Yes, Part B and Part D deductibles reset on January 1 each year. Part A deductibles reset when a new benefit period begins, which happens 60 days after you leave the hospital. If you don't use hospital services or don't meet your Part B deductible in a calendar year, you won't pay it that year — but it resets the next January regardless.

What's the difference between a deductible and coinsurance?

A deductible is a fixed amount you pay before Medicare starts to pay. Coinsurance is a percentage of the cost you pay after you've met your deductible. For example, with Part B you might pay a $240 deductible, then pay 20 percent coinsurance on doctor visits while Medicare pays 80 percent.

If I have a Medigap plan, do I still pay deductibles?

It depends on your Medigap plan. Some Medigap plans cover your Part A and Part B deductibles, so you pay nothing out of pocket. Others cover coinsurance but not deductibles. Check your Medigap plan documents or call your insurer to see what it covers. Medigap does not cover Part D deductibles.

Can my Part D deductible be waived?

Some Part D plans waive the deductible for certain drugs, usually maintenance medications you take regularly. Check your plan's formulary (the list of covered drugs) to see if any of your prescriptions are covered without a deductible. This varies by plan and by drug.

What happens if I don't meet my deductible before the year ends?

If you don't meet your deductible by December 31, it doesn't carry over to the next year. Your unused deductible is gone, and a new deductible amount resets on January 1. This is why some people schedule elective procedures late in the year if they've already met their deductible — they avoid paying a new deductible in January.