Medicare defines a deductible as:
“The amount you must pay for health care or prescriptions before Original Medicare, your prescription drug plan, or your other insurance begins to pay.”
In other words, a deductible is the amount that you must first pay out of your own pocket for health care before your Medicare insurance coverage kicks in.
In 2019, the Medicare Part B deductible is $185 per year.
Most deductibles reset every year, as is the case with the Medicare Part B deductible.
Each year that you are enrolled in Part B, you must first reach the deductible amount in your own health care spending before Medicare will begin to provide additional cost coverage.
Basically, any service or item that is covered by Part B counts toward your Part B deductible.
For example, imagine you fall and break your leg. You are taken to a hospital, treated, and released with a pair of crutches.
The care you receive as a hospital inpatient is covered under Medicare Part A (hospital insurance). But the crutches are covered under Medicare Part B (medical insurance).
The amount that you are charged for the doctor, treatment, and the crutches will count toward your Part B deductible, while the bill for your hospital stay will count toward your Part A deductible.
Each part of Medicare carries its own deductible. The Part A and Part B deductibles are standard for each beneficiary of Original Medicare.
The Part C (Medicare Advantage) and Part D (prescription drug plan) deductibles will vary from plan to plan. Some Part C and Part D plans may have a $0 deductible.
Once you meet the required Medicare Part B deductible, you will typically be charged a 20 percent coinsurance for all Part B-covered services and items for the remainder of the year.
Coinsurance is the amount of the total bill that you must pay. A 20 percent coinsurance means you (the beneficiary) would be responsible for 20 percent of a medical bill, while Medicare would pay the remaining 80 percent.
It’s worth noting that the 20 percent you will pay as coinsurance is 20 percent of the Medicare-approved amount.
The Medicare-approved amount is the maximum amount that a health care provider is allowed to charge for a service or item as determined by Medicare.
Let’s use the broken leg scenario from above and say that the cost of the pair of crutches was $80.
As mentioned above, the 2019 Medicare Part B deductible is $185 per year.
Below is a look at how the Part B deductible has increased (and in one case, decreased) since 2008.1
There are two ways you may be able to avoid having to pay the Medicare Part B deductible:
If you have further questions about the Medicare Part B deductible or any other costs associated with Medicare, explore our guide to Medicare costs.
Learn more about your Medicare enrollment options. If you want to have Medicare health coverage without having to pay the Medicare Part B deductible, you may want to consider enrolling in a Medicare Advantage plan.
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