Diving into the world of Medicare can sometimes seem overwhelming and, at times, stressful. The good news is it doesn’t have to be. You may find you’re unfamiliar with many of the terms related to Medicare, and that’s where we come in.

Below we’ll look further into what a Medicare deductible is and what this cost-sharing means.

How Medicare Deductibles Work

A Medicare deductible is one of the costs you’ll need to pay for your Medicare coverage. A deductible is an out-of-pocket expense or amount you pay toward your medical fees until your plan starts paying its share of costs. For most of your health care services and supplies, you’ll need to pay for the cost of treatment at the total price until you meet your deductible amount.

However, your Medicare plan may cover certain health services before you reach your deductible. It’s essential to know that each of the four parts of Medicare (Part A, B, C, and D) has deductibles. Those parts all work differently, and prices vary among insurance plans.

Deductible Under Medicare Part A

Medicare Part A (inpatient hospital coverage) helps cover your hospital and other inpatient care forms. Both hospital and inpatient stays at skilled nursing facilities are stressful for patients and their families. Health insurance coverage shouldn’t have to add any extra stress on you.

Let’s review what you can expect to pay in Medicare Part A deductibles. Overall, Medicare beneficiaries need to meet a deductible of $1,600 before Medicare picks up the remaining costs. It’s important to know that the Part A deductible is per benefit period, not per calendar year.

So, suppose you must stay at a medical facility as an inpatient. In that case, you’ll need to pay the first $1,600 before your Part A coverage kicks in once the beneficiary meets the deductible, a coinsurance (like a copayment) cost kicks in.

  • The first 60 days in a hospital or mental health facility require no coinsurance
  • A coinsurance of [GCBB#part-a-inpatient-coinsurance-days-61-90] per day is necessary for days 61 to 90 of your stay
  • A coinsurance of [GCBB#part-a-inpatient-coinsurance-days-91-120] per day is needed for days 91 and more of your visit, totaling 60 lifetime reserve days
  • A beneficiary’s lifetime reserve days come after exhausting 90 days of inpatient care — (60 full days and 30 coinsurance days) within the beneficiary’s benefit period

When staying as an inpatient in a skilled nursing facility:

  • The first 20 days of the stay won’t need a copayment
  • Days 21 to 100 require coinsurance of [GCBB#part-a-snf-copay-days-21-100] for each day
  • 101 Days and beyond, the beneficiary covers all costs

If hospice care is necessary, the beneficiary must cover copayments for drugs that may aid in symptom and pain control. A 5% coinsurance also applies to respite care. A 20% coinsurance amount may be required for the patient if durable medical equipment is necessary.

Deductible Under Medicare Part B

Medicare Part B helps to cover most outpatient care. Outpatient care includes:

Under Medicare Part B, you must meet the calendar year deductible of $226. Once you complete your Medicare Part B deductible, you might be responsible for 20% of the Medicare-approved amount to receive coverage for most health care services.

Remember, Part B may cover some services but not require a coinsurance or copayment — this is great news and may mean even more savings!

Deductible Under Medicare Supplement Plans

Medicare Part A and Part B (known as Original Medicare) cover a wide range of both medical supplies and health care services. However, as discussed above, Parts A and B carry annual deductibles, coinsurance, and plan premium costs. Part B may require you to pay 20% of the Medicare-approved amount for your services, and those extra costs tend to add up quickly.

One way to help soften the blow of these costs is to buy a Medicare Supplement plan (also known as Medigap coverage). A Supplement plan is a great option to help you pay for services you may not be able to afford. Medigap coverage helps cover coinsurance, copayments, and even deductibles!

Do you like traveling outside of the country? If so, Medicare Supplement plans may even help pay the costs of medical treatments you may receive while traveling outside the country. Medicare beneficiaries can buy supplement plans through private insurance carriers, and plans range in price and coverage. Even though Medigap plans charge a monthly premium, the ultimate savings may be worth it to you.

Deductible Under Medicare Advantage

A Medicare Advantage plan, also known as Medicare Part C, is an all-in-one, bundled plan. What exactly does this mean? You can buy a Medicare Advantage plan through a private insurance company that combines Part A, Part B, and usually, Part D coverages in one overall plan.

Most times, these plans are either PPOs or HMOs. If you choose a Medicare Advantage plan, you won’t need to pay for your Part A or B deductibles. Still, in most cases, you’ll need to pay a deductible for your prescription medications if you have Part D coverage rolled into your plan. Medicare Advantage plans come in all shapes, sizes, and prices. After you meet your plan’s deductible, you’ll then pay a set amount for your copay (for instance, $30 for physician visits) for your services.

Medicare Part C plans carry a maximum out-of-pocket cost, and those costs can’t be higher than $7,550 in . Your deductibles, copays, and other costs contribute to your out-of-pocket costs. Once you reach the out-of-pocket amount, your Advantage plan covers most expenses for the rest of the year.

Deductible Under Medicare Part D

Medicare Part D is known as your prescription drug coverage. Part D is optional coverage and carries an additional monthly premium. Much like Medicare Supplement and Advantage plans, prescription drug plans come in various costs and coverages.

Much like Medicare Part A, Part B, and Part C, Medicare Part D plans carry a deductible that you’ll pay before your plan covers its Part. The annual deductible limit for is $480. The beneficiary must pay 100% of the prescription drug costs with most Part D plans before Part D insurance covers any costs.

For instance, your plan may require you to pay an annual deductible of $480. Your Part D insurance won’t help pay for your medications until you’ve spent $480 on prescriptions first. Once you meet your deductible, your insurance kicks in. Depending on the plan you choose, your deductible may vary.

You’ll want to do your homework to be sure you’re getting the biggest bang for your buck when shopping for Part D drug plans. Some prescription drug plans may have a $0 annual deductible and only charge a monthly premium and a copayment. Others may carry a higher deductible and may have a lower premium cost. Some things you may want to consider when shopping for Part D plans include:

  • How many prescriptions do you take?
  • Type of prescription drugs you take, such as brand-name drugs and
    generic drugs
  • The out-of-pocket cost of your current medications
  • Deductible amounts of differing Part D plans

FAQs

What is the deductible for Medicare?

The deductible for Medicare is the set amount a beneficiary must pay out-of-pocket before the Medicare plan coverage kicks in and begins paying for services.

What is the Medicare Part A deductible?

In , you can expect to pay $1,600 for your Part A deductible.

What is the Medicare Part B deductible?

The cost for the Medicare Part B deductible in is $226.

How to Get Help Paying for Medicare Deductible

Understanding how Medicare deductibles work and how much they’ll cost you every year is crucial. When you buy a Medicare Supplement plan, it helps to cover both your Medicare Part A and your Part B deductible. This means more money in your pocket to spend the way you want.

Our licensed insurance agents can use their time and knowledge to your benefit. Their service is free of charge to you.

Give us a call today. Can’t talk right now? Then complete our online rate form to be connected with the best rates in your area!

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by Lindsay Malzone, Lindsay Malzone is the Medicare editor for Medigap.com. She's been contributing to many well-known publications since 2017. Her passion is educating Medicare beneficiaries on all their supplemental Medicare options so they can make an informed decision on their healthcare coverage.