Summary: Medicare deductibles are an out-of-pocket cost that you must pay before your Medicare coverage or plan starts to pay. Deductibles change annually and vary across each part of Medicare. In this article, we’ll cover the Medicare deductibles for 2023. Estimated Read Time: 6 min
What are Deductibles in Medicare?
Medicare deductibles are an amount you must pay before your Medicare coverage starts to pay. Deductibles vary across the different parts of Medicare. The Centers for Medicare and Medicaid Services establishes the deductible for Medicare Part A and Part B. These deductibles change annually and apply to all individuals enrolled in Original Medicare.
Medicare Advantage plans (Part C) and Medicare Part D prescription drug plans both have a variety of plans available, so deductibles vary between plans and carriers.
Typically, a deductible is paid once a year. Upon paying your deductible, your Medicare coverage begins paying for your Medicare-covered services and supplies. After your deductible is paid, you are still responsible for paying other out-of-pocket costs including premiums, copayments, and coinsurance. The Medicare Part A deductible differs from the rest: it is paid per benefit period.
Below, we’ll cover the 2023 deductible costs for Medicare. Keep in mind that your deductibles could differ if you are enrolled in Medicaid or have a Medicare Supplement Plan.
2023 Medicare Part A Deductible
The Medicare Part A deductible in 2023 is $1,600 for each inpatient benefit period. Unlike Medicare Part B, the Part A deductible is not an annual deductible. The Medicare Part A deductible is paid for each benefit period, which means you could pay the deductible multiple times a year.
How Medicare Benefit Periods Work
A Medicare benefit period begins when you are admitted to a hospital or skilled nursing facility. At this time, you will be responsible for paying the $1,600 Medicare Part A deductible. After you pay your deductible, you will be responsible for paying any copayments during your inpatient stay.
A Medicare benefit period ends once you haven’t gotten any inpatient care for 60 days in a row. If you are discharged from the hospital and are readmitted two weeks later, you are still in the same benefit period. However, if you are readmitted after 60 days, you will begin a new benefit period. This occurs even if you are admitted for the same condition or treatment.
Once a new benefit period begins, you will again be responsible for paying the $1,600 Medicare Part A deductible. There is no limit to how many inpatient benefit periods you can have in a year.
2023 Medicare Part B Deductible
The 2023 Medicare Part B deductible is $226 and is paid once each year. After paying your Medicare Part B deductible, your Medicare-covered services will typically cost you 20% out-of-pocket. Medicare will cover 80% of the cost of covered services and supplies, and you will be responsible for the remaining 20%. You may end up paying more if your provider does not accept Medicare assignment.
When a provider accepts assignment, they accept the Medicare-approved amount as the full payment. To reduce your out-of-pocket costs, check with your provider ahead of time to see if they accept Medicare assignment.
There is assistance available for low-income individuals who need help paying their Medicare Part B deductible. The Qualified Medicare Beneficiary (QMB) Program is a Medicare Savings Program that helps pay for Medicare Part A premiums and Medicare Part B premiums, deductibles, coinsurance, and copayments. This program has income and resource limits to qualify. You can apply for a Medicare Savings Program through your state.
2023 Medicare Part C Deductible
Your Medicare Advantage plan (Part C) deductible will vary based on your carrier and plan. Each year, your plan provider may change your plan’s annual deductible. When you enroll in a Medicare Part C plan, it becomes your primary source of health insurance. Because of this, you will no longer be responsible for your Original Medicare deductible.
Each Medicare Part C plan has an annual maximum out-of-pocket limit (MOOP). All your Medicare Part C out-of-pocket costs contribute to this limit, including your plan deductible.
If you qualify for both Medicare and Medicaid, you may be eligible for a Dual Eligible Special Needs Plan (SNP). Dual Eligible SNPs help coordinate your Medicare and Medicaid benefits. When using providers within your SNP’s network, you will typically not be responsible for paying your deductible; it will instead be paid by Medicaid.
2023 Medicare Part D Deductible
Medicare Part D prescription drug plan deductibles vary by plan and carrier. Since these prescription drug plans are offered by private insurance companies, their deductibles and other out-of-pocket costs vary. Though deductibles vary, Medicare does set a maximum Part D deductible amount each year. The maximum Medicare Part D deductible amount in 2023 is $505.
Not all Medicare Part D plans have a deductible. In some cases, a drug plan may have a deductible but will cover certain drugs before the deductible needs to be met. For example, you do not have to pay your Medicare Part D deductible prior to getting coverage for Part D-covered insulin.
Extra Help is available for individuals with limited income and resources who need help with their Medicare Part D costs. If you qualify for full Extra Help, you will have a $0 deductible for your prescription drug plan. If you only qualify for partial Extra Help, your plan’s annual deductible cannot be more than $104.
How to Get Help Paying Your Medicare Deductibles
Medicare Supplement Plans can help you pay for your Medicare deductibles. These plans, also known as Medigap Plans, are supplemental plans that help cover the out-of-pocket costs from Original Medicare. There are many plan types available, all of which are standardized. This means each plan must offer the same basic benefits regardless of carrier.
In the below chart, you’ll see which Medigap plans offer coverage for Medicare Part A and Part B deductibles.
Medicare Supplement Plans that Cover Medicare Deductibles
|Medicare Part A Deductible||X||X||X||X||X||X||X||50%||75%||50%||X|
|Medicare Part B Deductible||X||X||X|
*Medigap plans C, F, and High-Deductible F are only available to individuals who were considered eligible for Medicare prior to 2020
For individuals who became eligible for Medicare after January 1st, 2020, there are no Medigap plans available that cover the Medicare Part B deductible. There are, however, many plans still available that provide coverage for the Medicare Part A deductible.
If you are eligible for both Medicaid and Medicare, Medicaid may be able to help pay your Medicare deductibles. Individuals who have both Medicare and full Medicaid coverage are considered “dually eligible”. When you’re dual eligible, you will automatically qualify for Extra Help for drug coverage, which will eliminate your Medicare Part D deductible.
How to Learn More About 2023 Medicare Deductibles
Knowing your out-of-pocket costs, including your Medicare deductibles, will help you budget your healthcare coverage each year. As deductibles change annually, we understand keeping track of them can be difficult. That’s why our licensed insurance agents are here to help. Give us a call at the number above and we can help you figure out your deductibles for your Medicare coverage.