What Is a Medicare Deductible?

A deductible is the amount you pay out of your own pocket before your health insurance plan starts paying its share of the medical services or items you receive.

For example, if your plan includes a $2,000 deductible, you will be responsible for paying the first $2,000 worth of medical care yourself. Once you’ve contributed this amount, your insurance begins to pay its share of your health care.

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Medicare deductibles

Medicare Part A requires a deductible of $1,364 per benefit period in 2019. A benefit period begins the day you are admitted for inpatient care at a hospital or skilled nursing facility, and it ends when you have not received inpatient care for 60 days. The Medicare Part A deductible is not an annual deductible like many health insurance plans have.

The Medicare Part B deductible is $185 per year in 2019.

Deductibles for Medicare Part C (Medicare Advantage) and Part D (prescription drug plans) vary by each plan.

What counts toward your deductible?

In order for your medical payment to be counted toward your deductible, it must typically meet each of the following requirements:

  • The service or item must be received in-network or covered by Medicare
    Health care services and items may be counted toward your deductible as long as the services received are covered by Medicare or were received in network (if you have a private plan with a network of preferred providers).

    Private insurance plans may have a list of doctors, labs, medical equipment suppliers and other health care providers who contract with the plan. If you are enrolled in a private plan with a network, the costs of care or services you receive outside of your plan network might not be counted toward your deductible, or they may be counted towards an out-of-network deductible, depending on your plan.
  • The charges must be filed with your insurance company or with Medicare
    In order for your health care services to count toward your deductible, they must be properly reported to and filed with your insurance company. Your health care provider will typically use your insurance card (or Medicare card) to file your expenses on your behalf.

Getting help paying for Medicare deductibles

There are a few ways in which you might be able to avoid paying a deductible.

  • Some services, such as certain vaccines, screenings or wellness visits, may be covered in full with no deductible requirement.

  • Some Medicare Advantage plans and Part D plans feature $0 deductibles, though $0 deductible plans may not be available in all areas.

  • Some Medicare Supplement Insurance (Medigap) plans can provide coverage for certain Medicare deductibles.

If you have additional questions about how deductibles work or would like some help finding the right Medicare Advantage plan for your needs, contact a licensed insurance agent today by calling TTY Users: 711 24 hours a day, 7 days a week.

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MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts; enrollment in any plan depends upon contract renewal.

Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.

Medicare has neither reviewed nor endorsed this information.