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 — but you may still owe copayments or coinsurance on top of that.

Medicare has different deductibles depending on which part of coverage you use. Part A (hospital care) has one deductible. Part B (doctor visits and outpatient care) has a separate deductible. Part D (prescription drugs) has its own deductible too. If you have a Medigap or Medicare Advantage plan, your deductible may be different from Original Medicare.

The deductible amounts change each year. Medicare sets new amounts every January based on expected healthcare costs. This means what you paid last year may not be what you pay this year.

Key Takeaways

  • Part A has a deductible that applies per hospital stay, while Part B has an annual deductible that resets every January.
  • Part D prescription drug coverage has its own yearly deductible, which varies by plan.
  • Once you meet your deductible, you still pay copayments or coinsurance — the deductible is not your total out-of-pocket cost.
  • Medicare Advantage and Medigap plans set their own deductibles, which may be lower or higher than Original Medicare.
  • Deductible amounts change yearly, so check your plan documents or call Medicare each January to learn the new amounts.

Part A deductible for hospital stays

Part A covers inpatient hospital care, skilled nursing facility care, and some home health services. The Part A deductible applies per hospital stay, not per year. This means if you go to the hospital in January and again in December, you pay the deductible twice — once for each separate stay.

A hospital stay ends when you have not been an inpatient for 60 days in a row. If you are readmitted after that 60-day break, it counts as a new stay and you owe a new deductible. If you are readmitted within 60 days, it is considered part of the same stay and you do not owe another deductible.

After you pay the Part A deductible, Medicare covers all costs for days 1 through 60 of your hospital stay. On days 61 through 90, you pay a daily coinsurance amount. Beyond day 90, costs rise significantly, though you have a limited number of "lifetime reserve days" that Medicare will help cover.

Part B deductible for doctor and outpatient care

Part B covers doctor visits, outpatient services, lab tests, and medical equipment. The Part B deductible is an annual amount — you pay it once per calendar year, and it resets on January 1st. Once you meet it, Medicare typically pays 80 percent of approved charges and you pay 20 percent coinsurance.

The Part B deductible applies to most services, but not all. Some preventive care — like annual wellness visits, cancer screenings, and vaccinations — do not count toward the deductible. You can use Medicare's website or call 1-800-MEDICARE to find out whether a specific service requires you to meet the deductible first.

If you have a Medigap plan, it may pay your Part B deductible for you, which means you would not owe it out of pocket. Check your Medigap plan documents to see whether deductible coverage is included.

Part D prescription drug deductible

Part D covers prescription medications through private insurance plans. Each Part D plan sets its own deductible, so the amount varies widely depending on which plan you choose. Some plans have no deductible at all, while others have a deductible of several hundred dollars.

Once you meet your Part D deductible, you move into the "initial coverage" phase, where you pay a copayment or coinsurance for each prescription. The amount depends on the drug's tier — generic drugs usually cost less than brand-name drugs.

Part D has additional cost phases beyond the initial coverage phase, including a "coverage gap" (sometimes called the "donut hole") where you pay a higher percentage of drug costs. Understanding your plan's structure helps you predict what you will owe throughout the year.

Medicare Advantage plan deductibles

Medicare Advantage plans (Part C) are offered by private insurance companies and must cover everything Original Medicare covers, but they set their own deductibles and cost-sharing rules. Some Medicare Advantage plans have no deductible at all. Others have a deductible that applies to all services, or separate deductibles for different types of care.

Medicare Advantage plans often have lower deductibles than Original Medicare, but they may have higher copayments or coinsurance. They also typically require you to use doctors and hospitals in their network, with higher costs if you go out of network.

Your Medicare Advantage plan documents will show your specific deductible amount and how it works. If you are unsure, call the plan's customer service number — it is on your insurance card.

Medigap plan deductibles

Medigap (supplemental insurance) plans are sold by private companies to help pay costs that Original Medicare does not cover, such as copayments, coinsurance, and deductibles. Some Medigap plans pay your Part A and Part B deductibles entirely. Others require you to pay the deductible yourself before Medigap starts to help.

Medigap plans are labeled with letters (Plan A, Plan B, Plan C, and so on), and each letter has a standard set of benefits across all insurance companies. Plan A, for example, covers your Part B coinsurance and copayments but not your Part B deductible. Plan G covers your Part B deductible. Check your plan letter to see what deductible coverage is included.

Medigap does not cover Part D drugs, so you still need a separate Part D plan and will owe its deductible separately.

How to find out your deductible amount

Your deductible amount is printed in your plan documents, which you receive every year in the fall. Look for a section titled "Costs at a Glance" or "Your Costs" — this is where deductibles are listed.

You can also call 1-800-MEDICARE to ask about your deductible. Have your Medicare card handy. If you have a Medicare Advantage or Medigap plan, you can call the plan's customer service number directly — it is on your insurance card.

Medicare's official website (Medicare.gov) has a tool called "Plan Finder" where you can enter your information and see deductibles for all available plans in your area. This is helpful if you are comparing plans during the annual enrollment period.

Frequently Asked Questions

Does my deductible reset if I switch Medicare plans?

If you switch plans on January 1st, your new plan's deductible starts fresh. Any amount you paid toward your old plan's deductible does not carry over. If you switch mid-year, you may owe a deductible on the new plan even if you already met it on the old one, depending on the plan type.

What happens if I do not meet my deductible by the end of the year?

If you do not use enough healthcare services to reach your deductible, the unused amount does not roll over to next year. Your deductible resets on January 1st, and you start over. This is why some people with low healthcare needs may never meet their deductible in a given year.

Can I see my deductible progress during the year?

Yes. If you have Original Medicare, you can check your claims history on Medicare.gov to see what you have paid toward your Part B deductible. For Part D, your plan sends you statements showing your progress through the deductible and other cost phases. Contact your plan if you need clarification.

Do preventive services count toward my deductible?

Most preventive services covered by Medicare do not require you to meet your deductible first. These include annual wellness visits, cancer screenings, and certain vaccinations. However, if a preventive service becomes a treatment (for example, if a screening finds a problem that needs follow-up care), the follow-up may count toward your deductible.

What should I ask my doctor about deductibles?

Ask whether a recommended test or procedure is covered by Medicare and whether it counts toward your deductible. Ask if there are alternative tests that might cost less. If you are facing a large bill, ask whether the service can wait until next year when your deductible resets — sometimes timing matters for your out-of-pocket costs.