The Medicare Part B deductible is the amount you must pay for covered services before Medicare starts to pay its share

Under Medicare Part B, you pay a deductible each year before Medicare begins to cover your doctor visits, outpatient care, and other services. Once you meet this deductible, you then pay a percentage of the cost (called coinsurance) for most services for the rest of that year. The deductible amount changes each year — it is set by Medicare and announced in the fall for the following year.

The deductible applies to most Part B services, but not all. Some preventive services like annual wellness visits and certain screenings have no deductible. Understanding what counts toward your deductible and what does not will help you plan for your out-of-pocket costs.

Key Takeaways

  • You must pay the full cost of covered Part B services until you reach your yearly deductible, after which Medicare pays its share.
  • The deductible amount changes each year and applies separately from any Part A hospital deductible you may have.
  • Preventive services covered by Medicare, such as screenings and the annual wellness visit, do not require you to meet the deductible first.
  • Once you meet your deductible, you typically pay 20 percent coinsurance for doctor services and outpatient hospital care.

How the Part B deductible works each year

The deductible is an annual amount. This means it resets on January 1 of each year. You pay the full cost of covered services until the total you have paid reaches the deductible amount. After that point, Medicare pays its portion and you pay coinsurance (usually 20 percent) for the rest of the calendar year.

For example, if your deductible is $240 and you see your doctor for a visit that costs $150, you pay the full $150. If you then have lab work that costs $100, you pay $90 of that (to reach your $240 deductible) and Medicare pays $10. After you have paid $240 total, Medicare begins to cover its share of your remaining services for that year.

The deductible applies to most Part B services, including doctor office visits, outpatient hospital services, and diagnostic tests. It does not explore to emergency room visits (those fall under Part A), and it does not explore to preventive services.

Services that do not count toward your deductible

Medicare covers certain preventive services without requiring you to meet the deductible first. These include your annual wellness visit, certain cancer screenings (colorectal, breast, cervical), cardiovascular screenings, diabetes screenings, bone density tests, and vaccinations such as flu and pneumonia shots. You pay nothing for these services when you see an in-network provider.

Mental health services also have special rules. While mental health office visits do count toward your deductible, once you meet it you pay 20 percent coinsurance, the same as other doctor visits. Home health services and hospice care have their own payment rules and do not count toward the Part B deductible.

What happens if you have other insurance

If you have a Medigap policy (supplemental insurance), it may pay some or all of your deductible, depending on which plan you choose. Medigap Plan C and Plan F, for example, cover the Part B deductible entirely. Other plans cover part of it. You should review your Medigap policy documents to see what your plan covers.

If you have coverage through a current employer or union, that insurance may pay toward your Part B deductible before Medicare does. The order in which insurances pay is called coordination of benefits. Your employer plan documents will explain how it works with Medicare.

If you have a Medicare Advantage plan (Part C), the deductible rules are different. These plans set their own deductibles, which may be higher, lower, or the same as Original Medicare. Your plan documents will show your specific deductible amount.

How to track what you have paid toward your deductible

Medicare sends you an Explanation of Benefits (EOB) after each service you receive. This document shows what the service cost, what Medicare paid, and what you owe. Keep these documents and add up what you have paid out of pocket to track your progress toward meeting the deductible.

You can also check your deductible status online through your Medicare account at Medicare.gov. Log in, go to "Claims," and you will see a summary of what you have paid toward your deductible for the current year. If you do not have an online account, you can call Medicare at 1-800-MEDICARE to ask how much of your deductible you have met so far.

Planning for your Part B costs

Because the deductible resets each January, some people schedule medical appointments in late December or early January depending on their financial situation. If you know you will need several services, you might want to spread them across two calendar years to manage your out-of-pocket costs, or you might prefer to get them done early in the year so you meet your deductible sooner.

Talk with your doctor's office about costs before your visit. They can tell you whether the service counts toward your deductible and what you are likely to owe. If cost is a concern, ask whether there are lower-cost alternatives or whether the service can wait until next year.

Questions to ask your doctor or Medicare

Before a service or procedure, ask your doctor's office: "Does this service count toward my Part B deductible?" and "What will I owe out of pocket?" You can also ask whether the service is preventive (which would not require the deductible) or whether it can be done as an outpatient service versus an inpatient stay (which would fall under Part A instead).

If you receive a bill that seems wrong, compare it to your Explanation of Benefits. If the amounts do not match, call the provider's billing department and ask them to explain the charges. You can also contact Medicare at 1-800-MEDICARE if you believe Medicare should have paid more.

Frequently Asked Questions

Does my Part B deductible carry over if I do not meet it by the end of the year?

No. The deductible resets on January 1 each year. Any amount you have not used by December 31 does not roll over. If you have not met your deductible by year-end, you start fresh with a new deductible amount in January.

If I have both Part A and Part B, do I pay two separate deductibles?

Yes. Part A (hospital insurance) has its own deductible, which applies to inpatient hospital stays. Part B (medical insurance) has a separate deductible for doctor visits and outpatient services. You must meet both deductibles if you use both types of care during the year.

What if I see an out-of-network doctor?

Original Medicare does not have a network — any doctor who accepts Medicare is in-network. You pay the same deductible and coinsurance whether you see a doctor in a large city or a small town. However, if you have a Medicare Advantage plan, out-of-network doctors may cost you more or may not be covered at all.

Do I pay the deductible for telehealth visits?

Yes, telehealth visits with your doctor count toward your Part B deductible the same way in-person visits do. Once you meet your deductible, you pay 20 percent coinsurance for telehealth services. Preventive telehealth visits, such as a virtual wellness check-up, do not require the deductible.

Can I pay my deductible all at once instead of spreading it across the year?

No. You pay the deductible as you use services throughout the year. You cannot prepay it. However, if you know you will need several services, you can schedule them early in the year to meet your deductible sooner and then pay only coinsurance for the rest of the year.