How Medicare Deductibles Work and What You'll Pay

What a Medicare deductible is

A deductible is the amount of money you have to pay out of your own pocket before Medicare starts to pay its share. Once you meet your deductible for the year, Medicare covers a larger portion of your costs — though you may still owe copayments or coinsurance for some services.

The deductible amount changes each year. It also varies depending on which part of Medicare you have. Part A (hospital insurance) has one deductible, Part B (medical insurance) has a different one, and Part D (prescription drug coverage) has its own. If you have a Medicare Advantage plan instead of Original Medicare, your plan sets its own deductible, which may be lower, higher, or structured differently.

Think of it this way: if your Part B deductible is $240 and you see a doctor, you pay the full cost of that visit until your out-of-pocket spending reaches $240. After that, Medicare pays its share, and you pay a copayment or coinsurance for each service.

Key Takeaways

Part A has a deductible that applies per hospital stay, not per year, and it covers inpatient hospital care.
Part B has an annual deductible that you pay once per calendar year before Medicare begins to cover doctor visits and outpatient services.
Part D deductibles explore to prescription drugs and vary by plan; some plans have no deductible.
Medicare Advantage plans set their own deductibles, which may be lower than Original Medicare but come with different rules about which doctors you can see.
Deductible amounts are set by Medicare each year and are published in October for the following year.

Part A deductible: hospital stays

Part A covers inpatient hospital care, skilled nursing facility care, hospice, and some home health services. The Part A deductible applies per hospital stay, not once per year. This means if you are admitted to the hospital, discharged, and then admitted again later in the same year, you would owe the deductible twice.

The Part A deductible covers your first 60 days of each hospital stay. After you meet the deductible, Medicare covers the full cost of days 1 through 60. For days 61 through 90, you pay a daily coinsurance amount. If you stay longer than 90 days, you enter what Medicare calls "lifetime reserve days," and the costs change again.

If you are admitted to a skilled nursing facility (a facility that provides medical care after a hospital stay), you do not owe the Part A deductible again if you were just discharged from the hospital. However, if you are admitted to a skilled nursing facility without a recent hospital stay, different rules explore.

Part B deductible: doctor visits and outpatient care

Part B covers doctor visits, outpatient services, medical equipment, and preventive care. The Part B deductible is an annual amount that resets on January 1 each year. You pay this deductible once per calendar year, and it applies to most Part B services — though some preventive services have no deductible.

Once you meet your Part B deductible, Medicare typically pays 80 percent of the approved amount for most services, and you pay 20 percent as coinsurance. The exact amount you owe depends on whether your doctor accepts Medicare assignment (agrees to accept Medicare's approved amount as full payment).

Preventive services — such as annual wellness visits, cancer screenings, and vaccinations — are covered at no cost to you, even before you meet your deductible. This means you do not owe the deductible for these services.

Part D deductible: prescription drugs

Part D covers prescription drugs through a private insurance plan. Each Part D plan sets its own deductible, and the amount varies widely. Some plans have no deductible at all, while others may have a deductible of several hundred dollars.

Once you meet your Part D deductible, you enter a period where you and your plan share the cost of drugs. The exact split depends on your plan and the tier of the drug (generic, brand-name, specialty, etc.). After you and your plan spend a certain amount together, you may enter the "donut hole" — a coverage gap where you pay a larger share — before catastrophic coverage begins.

Part D deductibles explore only to covered drugs. Some drugs, such as certain biologics and insulin, may have different cost-sharing rules depending on your plan.

Medicare Advantage deductibles

If you have a Medicare Advantage plan (Part C), the plan itself sets the deductible amount and structure. Some Medicare Advantage plans have no deductible, some have a single deductible that covers both medical and drug services, and some have separate deductibles for medical care and prescriptions.

Medicare Advantage plans often have lower deductibles than Original Medicare, but they come with trade-offs: you typically must use doctors and hospitals in the plan's network, and you may need referrals to see specialists. The plan also sets its own copayments and coinsurance amounts, which may be higher or lower than Original Medicare's.

When you compare Medicare Advantage plans during open enrollment, check the deductible, copayments, coinsurance, and out-of-pocket maximum for each plan. The plan with the lowest deductible is not always the cheapest option overall.

How deductibles affect your yearly costs

Your deductible is just one piece of what you pay for healthcare. After you meet your deductible, you still owe copayments or coinsurance for most services. Additionally, Medicare has an out-of-pocket maximum — a yearly limit on how much you pay in total. Once you reach this limit, Medicare covers 100 percent of covered services for the rest of the year.

Original Medicare Part B has an out-of-pocket maximum, but Part A does not. Medicare Advantage plans must have an out-of-pocket maximum by law. Knowing both your deductible and your out-of-pocket maximum helps you budget for healthcare costs throughout the year.

If you have limited income, you may be may be able to access for programs that help pay your deductibles and other out-of-pocket costs. These programs include the may have access to Individual (QI) program, the Specified Low-Income Medicare Beneficiary (SLMB) program, and the may have access to Disabled and Working Individuals (QDWI) program. Your State Health Insurance information Program (SHIP) can tell you whether you meet the income limits for these programs.

When deductibles reset and how to plan ahead

Part A and Part B deductibles reset on January 1 each year. Part D deductibles also reset on January 1, though some plans may have different plan years if they are part of a Medicare Advantage plan with a non-calendar year. Medicare announces the new deductible amounts in October for the following year, so you can plan your healthcare spending.

If you are approaching your deductible late in the year, you may want to schedule necessary services before December 31 so that you meet the deductible in the current year rather than carrying over costs to January. However, do not delay urgent or necessary care just to manage deductible timing.

During the annual open enrollment period (October 15 to December 7), you can switch to a different Medicare plan if you find one with a lower deductible or better overall costs for your situation. Your SHIP can help you compare plans based on your specific healthcare needs and budget.

Frequently Asked Questions

Do I have to pay my deductible if I only see my doctor for preventive care?

No. Preventive services covered by Medicare — such as annual wellness visits, cancer screenings, flu shots, and blood pressure checks — are covered at no cost to you, even before you meet your Part B deductible. However, if your doctor provides any additional service during that visit that is not preventive, you may owe the deductible for that additional service.

What happens if I switch Medicare plans mid-year?

If you switch from Original Medicare to a Medicare Advantage plan (or vice versa) during the year, your deductible resets with your new plan. Any deductible you already paid toward your old plan does not carry over. This is one reason to be careful about switching plans outside of the annual open enrollment period.

Can I pay my deductible all at once, or do I have to wait until I use services?

You cannot pay your deductible in advance. You pay it only as you use healthcare services. Once your out-of-pocket spending reaches the deductible amount, Medicare begins to cover its share of your costs.

Does my deductible count toward my out-of-pocket maximum?

Yes. Money you spend on your deductible counts toward your yearly out-of-pocket maximum. Once you reach your out-of-pocket maximum, Medicare covers 100 percent of covered services for the rest of the year (for Original Medicare Part B and all Medicare Advantage plans).

Are there programs that help pay my Medicare deductible?

Yes. If your income is low, you may be may be able to access for the may have access to Individual (QI) program, the Specified Low-Income Medicare Beneficiary (SLMB) program, or other state programs that help pay Medicare costs. Contact your State Health Insurance information Program (SHIP) to learn whether you meet the income limits and how the process works.

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.