Is There a Medicare Deductible?
Summary: Medicare Part A and Part B have deductibles you may have to pay. Medicare Part C and Part D may or may not have deductibles, depending on the plan.
Original Medicare has two parts: Part A for hospital insurance and Part B for medical insurance. Each covers different services and has different costs for the beneficiary. Both Part A and Part B have deductibles that you may need to pay before certain benefits are covered.
More than half of Medicare beneficiaries surveyed listed Medicare deductibles and copayments as a major concern.
Source: Concerns about Coverage and Costs in Medicare: A Survey of Medicare Beneficiaries
The 2018 eHealth study included over 1,000 Medicare beneficiaries.
Medicare Part A deductible
Medicare Part A benefits include inpatient hospital care, skilled nursing facility care, home health services, and hospice.
For a hospital stay, you usually have to pay the Part A hospital inpatient deductible, which is $1364 in 2019 for each benefit period. You may have other costs for the specific health-care services you receive while in the hospital. On the 61st day of a hospital stay, you would also start to have coinsurance costs. Your coinsurance costs depend on the length of your stay:
- Days 61 to 90: Daily coinsurance of $341 in 2019 for each benefit period
- Days 91 and over: Daily coinsurance of $682 in 2019 for each “lifetime reserve day” in each benefit period (up to a maximum of 60 days over your lifetime)
- After lifetime reserve days are used up: You pay all costs
For home health-care services, all costs are covered under Medicare Part A for a limited time under certain conditions. However, if your doctor orders durable medical equipment and supplies it as part of your care, you’ll pay 20% of the Medicare-approved amount for the equipment.
For hospice care, all costs are covered. Some exceptions include:
- If you take prescription medications or similar items for pain relief or symptom control while on hospice. You may be responsible for a copayment of no greater than $5 per prescription drug.
- If you need inpatient respite services. You may need to pay 5% of the Medicare-approved amount for that care.
- If you get hospice care in a nursing home. You typically pay for room and board costs.
Medicare Part B deductible
Medicare Part B benefits include (but aren’t limited to) doctor’s office visits, preventive screenings, and durable medical equipment. For some of these services, a deductible will apply ($185 in 2019). Often, you will pay 20% of the Medicare-approved amount for a health-care service after this deductible is met. Make sure to check with your doctor and Medicare because each benefit’s coverage is different.
Medicare Supplement (Medigap) insurance plans and Medicare deductibles
To get help paying for your Medicare deductibles, you might consider a Medicare Supplement (Medigap) insurance plan. If you have Original Medicare, you can get this additional insurance to help cover some of your Medicare expenses. There are 10 standardized Medigap plans that are available in most U.S. states; Massachusetts, Minnesota, and Wisconsin have their own types of Medicare Supplement insurance plans. Not every Medigap plan covers the Part A and/or Part B deducible, but most of the standardized plans cover at least one of these deductibles in full or partially.
If you’re concerned about Medicare deductibles and planning for future costs, you may want to consider all your options, including Medicare Supplement insurance plans. To get help finding a Medicare insurance plan, you can type your zip code into the form on this page to see a list of Medicare plans in your vicinity.
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