You’ll pay a deductible when you use Medicare Parts A, B, C, or D. Your deductible is the cost-sharing portion you’re responsible for in each part of Medicare. The deductible is paid prior to Medicare covering your claims. Read on to learn more about Medicare deductibles and how you can minimize them.
Tina has surgery. Her bill comes to $7,500 and her Medicare plan has a $1,556 deductible. Tina will be responsible for $1,556 out of pocket before the Medicare plan covers anything. After Tina pays the deductible, Medicare or the insurance company will pay its portion of the remaining $5,944.
Does Original Medicare Have Deductibles?
Original Medicare has deductibles for Parts A and B. Deductibles for Original Medicare change each year starting January 1. Once you have met your deductible, you will not need to meet it again for the benefit period of the part of Medicare you are using.
What Is the Medicare Part A deductible?
For 2022, the Medicare Part A deductible is $1,556 per benefit period. The benefit period for Medicare Part A ends 60 days after you no longer need inpatient services. After this benefit period, if you are readmitted to the hospital, you will pay a new deductible.
Medicare Part A covers inpatient hospital care, skilled nursing care, hospice, and home health care after a qualifying hospitalization. Qualifying hospitalizations are at least three days inpatient. It is important to know that observation periods within a hospital do not count as an inpatient hospitalization. Furthermore, Part A does not cover long-term care or custodial services ― only skilled nursing services.
What Is the Medicare Part B deductible?
The Part B deductible for 2022 is $233. Medicare Part B’s benefit period is the entire calendar year. After your deductible is met, Medicare will cover 80% of all approved costs. You will be responsible for the remaining 20%.
Medicare Part B covers outpatient services, inpatient and outpatient mental health services, medications delivered in a doctor’s office, and durable medical equipment (DME). Emergency room (ER) visits and periods of observation fall under Part B when they do not result in an admission.
Do Medicare Advantage Plans Have Deductibles?
Most Medicare Advantage Plans ― also known as MA or Medicare Part C ― do have deductibles associated with inpatient services, but the amount is not universal.
Instead, Medicare Advantage Plans, which are administered by private insurance companies, have a secondary cost protection measure for users. This is called the maximum out-of-pocket (MooP) amount. For 2022, the MooP for Medicare Advantage Plans is $7,550 for in-network services.
MooP costs accrue when you pay copays, coinsurance, and deductibles outlined in the plan benefits. Once the MooP is met, the Medicare Advantage Plan covers all additional costs for the rest of the calendar year.
Medicare Advantage Plans can, and often do, change from year to year. Reviewing your Medicare Advantage Plan during the annual open enrollment period (OEP) is a good way to avoid surprises associated with your plan.
Does Medicare Part D Have Deductibles?
Like Medicare Advantage Plans, Medicare Part D varies based on the plan you select. If your Part D plan does have a deductible, it may not be more than $480 in 2022. However, this deductible may not apply to all drugs. Many plans offer no deductible for Tier 1 drugs.
Evaluate your estimated overall out-of-pocket costs when comparing Medicare Part D plans. The cost is the monthly premium plus the estimated cost of your specific drugs. Even with a higher monthly premium, your overall costs may be lower than a plan that costs less monthly.
Do Medicare Supplement Plans Have Deductibles?
The only service that has a deductible from the Medicare Supplement (Medigap) plans is the foreign travel benefit. This benefit offers a $50,000 lifetime maximum for emergency services when traveling outside of the U.S. and associated territories. There is a 20% out-of-pocket coinsurance payment after the $250 deductible and the emergency must happen 60 days from the start of your trip.
Can You Use a Medigap Plan to Pay Original Medicare Deductibles?
Medicare Supplement plans can be used to pay some or all of Medicare deductibles. However, the amount that is covered under a Medigap plan depends on the plan letter you select.
If you were eligible for Medicare Part B prior to January 1, 2020, you can purchase Medigap Plan C or F. These plans cover 100% of Medicare Part A and B deductibles. After this date, Plan C and F are no longer available to new Medicare beneficiaries.
Current Medigap plans offer different benefits for covering Part A, which you can see below:
|Medicare Supplement Part A Deductible Coverage|
All current plans require that you pay the Part B deductible prior to receiving any benefit from Medicare or the Medicare Supplement policy.
Do Medicare Deductibles Ever Change?
Medicare deductibles often change annually. This is also true for Medicare Advantage and Part D plans. It is important to review your “Medicare and You” handbook annually to be made aware of your Original Medicare deductibles. You should also review your Part C and D plans with a professional annually during the OEP to ensure you are still using a plan that meets your needs.
Learn More From Our Sources
- CMS | Medicare Open Enrollment | Last accessed April 2023
- Medicare | What Part A covers | Last accessed April 2023
- Medicare | What Part B covers | Last accessed April 2023