Original Medicare (Parts A and B), Medicare Advantage (Part C), and Medicare Part D all have a deductible that a person must meet each year before full coverage begins.
Medicare sets specific deductibles for various parts each year. As these change annually, individuals should always check their plan information for up-to-date information on deductibles and other out-of-pocket costs.
Glossary of Medicare terms
We may use a few terms in this article that can be helpful to understand when selecting the best insurance plan:
- Out-of-pocket costs: An out-of-pocket cost is the amount a person must pay for medical care when Medicare does not pay the total cost or offer coverage. These costs can include deductibles, coinsurance, copayments, and premiums.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before an insurer starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, this is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
A deductible is the amount a person must pay before their insurance begins paying for covered expenses. This amount can vary widely between insurance companies and types.
Medicare sets specific deductibles for the different parts each year. Individuals must meet the deductible for each part before that specific type of coverage begins.
For example, a person must meet the Part D deductible before Medicare will begin to cover prescription medications.
Individuals should always check their Medicare Summary Notice or contact Medicare for more information.
Medicare Part A (hospital insurance) covers inpatient care in a hospital or other approved facility, such as a skilled nursing facility. This part of Original Medicare (Parts A and B) covers the care, services, and medication a person receives while in the hospital or other facility.
In 2024, the Part A deductible is $1,632 for each time a hospital admits an individual during a benefit period. A benefit period begins on the day of a hospital admission and ends when the person is no longer receiving inpatient care for 60 days in a row. There is no limit to how many benefit periods an individual can have.
Other costs include the following copayments for each inpatient stay:
- Days 1 to 60: $0 after a person meets the deductible
- Days 61 to 90: $408 per day
- Days 91 to 150: $816 per day while using the 60 lifetime reserve days
- After day 150: the individual is responsible for all costs
Read more about Part A coverage.
Medicare Part B (medical insurance) covers two types of services:
- Medically necessary: These are services and supplies that meet the standards of medical practice to diagnose or treat a condition.
- Preventive: These are health services that help prevent illness or detect a condition at an early stage when treatment is most likely to be effective. Preventive services may include vaccinations and condition screenings.
The deductible for Part B in 2024 is $240. Once an individual reaches this deductible, they are then generally responsible for 20% of all Medicare-approved services.
Other costs for Part B include the monthly premium. In 2024, the standard monthly premium is $174.70. If an individual has a yearly income over $103,000, they will have to pay a higher monthly premium.
Medicare Part D plans are optional prescription drug plans. They are in addition to Original Medicare or Medicare Advantage, and many Medicare Advantage plans include prescription drug coverage.
However, individuals can choose a stand-alone Part D plan. Medicare-approved insurance companies provide these.
While Part D plans are optional, it is important for individuals with Medicare to have a creditable prescription drug coverage plan, which is coverage expected to pay at least as much as a Medicare Part D plan would. A person who does not have this kind of plan may be subject to a late enrollment penalty.
The deductibles for Part D vary by plan. Individuals should check with their insurance provider for their plan deductibles.
Learn more about Medicare Part D.
Medicare Advantage (Part C) is an alternative to Original Medicare. Medicare-approved insurance companies provide these plans.
Medicare Advantage plans are bundled plans that include the same coverage as Parts A and B. Many of these plans also include prescription drug coverage (Part D).
Out-of-pocket costs, such as deductibles, vary by plan. Individuals can check with their plan provider for more information about deductibles, premiums, and out-of-pocket limits.
Read about Original Medicare vs. Medicare Advantage.
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
Deductibles are the amount a person has to pay out of pocket before their Medicare plan begins to pay for coverage of care and services. Medicare and Medicare-approved insurance providers set these limits annually.
Once a person meets their yearly deductible, they are then generally responsible for 20% of the approved coverage costs.
Private insurance companies provide Part D and Medicare Advantage plans. This means deductibles vary by plan. A person can check with their insurance provider for more information on deductibles and other costs.