Do You Have to Meet a Deductible With Medicare?
Do you pay deductibles with Medicare? Understand how these costs affect your healthcare coverage and how to manage your financial responsibility.
Medicare, the federal health insurance program, involves various cost-sharing requirements. A deductible is an amount you pay out-of-pocket for covered healthcare services or prescriptions before your insurance coverage begins to contribute. Beneficiaries are responsible for meeting deductibles associated with several Medicare parts before benefits are paid.
Understanding Medicare Deductibles
Deductibles are amounts beneficiaries must pay for covered services or prescriptions before Medicare begins to pay its share. Original Medicare, which includes Part A (Hospital Insurance) and Part B (Medical Insurance), each has its own distinct deductible structure. Medicare Part D, which provides prescription drug coverage, also includes deductibles.
Medicare Part A Deductible
Medicare Part A covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health services. The Part A deductible applies per “benefit period,” not annually. A benefit period begins the day you are admitted as an inpatient in a hospital or skilled nursing facility. It ends when you have been out of a hospital or skilled nursing facility for 60 consecutive days. For 2025, the Medicare Part A deductible is $1,676 per benefit period.
Medicare Part B Deductible
Medicare Part B covers most doctor visits, outpatient services, preventive care, durable medical equipment, and other medical services. Unlike Part A, the Part B deductible is an annual amount. For 2025, the annual deductible for Medicare Part B beneficiaries is $257. Once this deductible is met, Medicare generally pays 80% of the Medicare-approved amount for most covered services, and the beneficiary is responsible for the remaining 20% coinsurance.
Medicare Part D Deductibles
Medicare Part D provides prescription drug coverage through private insurance companies approved by Medicare. Some Part D plans have no deductible, while others require beneficiaries to meet one before the plan starts paying for prescription drugs. The maximum deductible allowed for a Medicare Part D plan in 2025 is $590. After the deductible is met, beneficiaries typically pay a portion of their drug costs through copayments or coinsurance.
Managing Medicare Deductibles
Beneficiaries have options to manage their Medicare deductibles and other out-of-pocket costs. One common approach involves purchasing a Medigap policy, also known as Medicare Supplement Insurance. These plans help to pay for the “gaps” in Original Medicare, including deductibles, coinsurance, and copayments. Different Medigap plans offer varying levels of coverage for these expenses.
Another way to manage costs is through Medicare Advantage Plans (Medicare Part C). These plans are offered by private insurance companies and provide an alternative to Original Medicare. Medicare Advantage plans generally do not have the separate Part A and Part B deductibles found in Original Medicare. Instead, they often feature their own cost-sharing arrangements, such as copayments and coinsurance for services, and typically include an out-of-pocket maximum that limits a beneficiary’s annual spending for covered services.