What a Medicare deductible is

A Medicare deductible is the amount of money you have to pay out of your own pocket before Medicare starts to pay its share of your medical bills. 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 and is different for each part of Medicare. Part A (hospital insurance) has one deductible, Part B (medical insurance) has another, and Part D (prescription drug coverage) has its own. Medigap and Medicare Advantage plans also set their own deductibles, which may be lower or higher than Original Medicare.

Understanding your deductible matters because it directly affects how much you spend before your coverage kicks in. A higher deductible usually means lower monthly premiums, while a lower deductible means you pay more each month but less when you actually need care.

Key Takeaways

  • Part A has a deductible that covers a hospital stay; Part B has a separate deductible for doctor visits and outpatient services.
  • Once you meet your deductible, you still pay coinsurance or copayments for most services — the deductible is not your total out-of-pocket cost.
  • Medicare Advantage and Medigap plans set their own deductibles, which may differ from Original Medicare amounts.
  • Deductible amounts reset on January 1 each year, so costs you paid in December do not carry over.
  • Some preventive services have no deductible under any Medicare plan.

Part A deductible for hospital stays

Part A covers inpatient hospital care, skilled nursing facilities, hospice, and some home health services. The Part A deductible applies per benefit period, not per year. A benefit period begins when you enter the hospital and ends after you have been out for 60 days in a row.

If you are readmitted to the hospital after that 60-day break, a new benefit period starts and you owe a new deductible. This means you could owe multiple Part A deductibles in a single calendar year if you have separate hospital stays. The deductible amount varies year to year; you can find the current amount on Medicare.gov or by calling 1-800-MEDICARE.

After you meet the Part A deductible, Medicare covers all approved hospital costs for days 1 through 60 of your stay. For days 61 through 90, you pay a daily coinsurance amount. Beyond 90 days, costs rise significantly, which is why understanding your coverage limits matters.

Part B deductible for doctor visits and outpatient care

Part B covers doctor visits, outpatient services, medical equipment, and some preventive care. The Part B deductible is a calendar-year deductible, meaning it resets on January 1 each year. Once you pay this amount toward covered Part B services, Medicare covers 80 percent of approved charges and you pay 20 percent coinsurance.

The Part B deductible applies to most services but not all. Preventive services — like annual wellness visits, cancer screenings, and vaccinations — have no deductible. If you see your doctor for a preventive service in January, that visit does not count toward your deductible, even though you may owe a copayment at the visit itself.

Part B deductibles explore whether you see a doctor in a hospital outpatient department, an urgent care center, or a private office. The key is that the service must be covered by Part B and not classified as preventive.

Part D prescription drug deductible

Part D covers prescription medications through a private insurance plan you choose. Each Part D 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, while others require you to pay the full cost of medications until you meet the deductible.

Once you meet your Part D deductible, you enter the initial coverage phase, where you and your plan share the cost of medications. The amount you pay depends on whether the drug is a generic, preferred brand, or non-preferred brand on your plan's formulary — the list of covered drugs.

Part D has an additional cost phase called the "donut hole" or coverage gap. After you and your plan spend a certain amount on drugs, you pay a higher percentage of costs until you reach catastrophic coverage. Understanding your specific plan's deductible and cost structure is important because plans differ widely.

Medicare Advantage and Medigap deductibles

Medicare Advantage plans (Part C) combine Part A, Part B, and usually Part D coverage into one plan run by a private insurance company. These plans set their own deductibles, which may be lower, higher, or the same as Original Medicare. Some Medicare Advantage plans have zero deductible, while others have separate deductibles for hospital care and doctor visits.

Medigap (supplemental insurance) works differently. Medigap plans do not have deductibles for most coverage — instead, they pay the coinsurance and copayments that Original Medicare does not cover. However, some Medigap plans do have small deductibles before they begin paying. Plan G, for example, has a deductible that resets each year.

If you have a Medicare Advantage plan, your deductible information appears in your plan documents and on your insurance card. If you have Original Medicare plus a Medigap plan, you owe the Original Medicare deductible first, then Medigap covers what it is designed to cover.

How deductibles work across the calendar year

Part A and Part B deductibles reset on January 1 each year. This means if you meet your Part B deductible in November, you start fresh on January 1 and owe a new deductible for any Part B services you use in the new year. Part A deductibles reset by benefit period, not by calendar date, so the timing is different.

Part D deductibles also reset on January 1, though some plans have a different plan year if they are part of a Medicare Advantage plan with a non-calendar year. You can find your plan's year in your plan documents.

Costs you paid in December toward your deductible do not carry over into January. If you are close to meeting your deductible late in the year, it may make sense to schedule certain services before year-end, but this is a decision to discuss with your doctor based on medical need, not just cost.

Services with no deductible

Medicare covers certain preventive services with no deductible under Part B. These include annual wellness visits, cancer screenings (mammograms, colonoscopies, Pap tests), cardiovascular screenings, diabetes screenings, bone density tests, and most vaccinations. You may still owe a copayment at the time of service, but the visit itself does not count toward your deductible.

Some mental health services and substance use disorder treatment also have no deductible. If you are unsure whether a specific service has a deductible, ask your doctor's office or call your Medicare plan before your appointment.

Part A covers certain home health services with no deductible if you meet the homebound requirement and your doctor orders the care. Hospice care also has no deductible, though you may owe small copayments for medications and respite care.

Frequently Asked Questions

Do I owe my deductible every year?

Yes. Part A and Part B deductibles reset on January 1 each year, so you owe a new deductible in 2024 even if you met it in 2023. Part A deductibles also reset each time a new benefit period begins — which happens 60 days after you leave the hospital — so you could owe multiple Part A deductibles in one calendar year.

What happens after I meet my deductible?

After you meet your Part B deductible, Medicare covers 80 percent of approved charges for most services and you pay 20 percent coinsurance. For Part A, coverage depends on how many days you have been in the hospital. After you meet your Part D deductible, you enter the initial coverage phase where you and your plan share medication costs.

Can I use preventive services without meeting my deductible first?

Yes. Preventive services like annual wellness visits, cancer screenings, and vaccinations have no deductible. You may owe a copayment at the visit, but the service does not count toward your deductible, so you do not have to wait to use these services.

Are deductibles the same in every state?

Deductible amounts are set by Medicare and are the same nationwide for Original Medicare (Part A and Part B). Part D and Medicare Advantage deductibles vary by plan and by state because private insurance companies set them. You can compare plans in your area on Medicare.gov.

What if I have both Original Medicare and a Medigap plan?

You owe the Original Medicare deductible first. Once you meet it, Medigap covers the coinsurance and copayments that Original Medicare does not pay, depending on which Medigap plan you have. Some Medigap plans have their own small deductible, so check your plan documents.