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How Often Does a Medicare Deductible Apply?

Medicare offers government-sponsored health insurance primarily to people age 65 and older. Most health insurance, including Medicare, has a deductible amount that you must pay before the insurance starts paying for your medical care. The deductible for Medicare Part A is based on benefit periods, while Part B has an annual deductible. The deductibles for Part C and Part D depend on the specific plan that you purchase.

  1. Part A Benefit Periods

    • The deductible for Medicare Part A is based on a benefit period. You pay a deductible for each benefit period. A benefit period starts on the day you go into a hospital or skilled nursing facility. When you haven't received any hospital or skilled nursing care for 60 days in a row, the benefit period ends. If you go into a hospital or nursing facility after the end of a benefit period, a new benefit period begins, and you pay a new deductible for the new benefit period. For each benefit period, the deductible in 2011 is $1,132.

    Part A Coverage

    • Part A covers a semiprivate hospital room, hospital meals, and eligible hospital services for up to 90 days during each benefit period. After the deductible, Medicare pays all covered charges in full for the first 60 days in a hospital. From day 61 through 90, in 2011, you pay $283 a day coinsurance. After 90 days, you pay all charges in full, unless you haven't used your 60 lifetime reserve days yet. When you have reserve days to use, your coinsurance in 2011 for those days is $566 a day. If you have a covered hospital stay of at least three days and then to a skilled nursing facility, Medicare covers all eligible nursing facility charges for the first 20 days during that benefit period. For days 21 through 100, in 2011, you pay coinsurance of $141.50 a day. You pay all costs after day 100.

    Part B Deductible

    • Medicare Part B covers doctors' services, outpatient hospital care, durable medical equipment and some preventive care. Part B has an annual deductible, which in 2011 is $162. After the deductible, Medicare pays 80 percent of most Medicare-approved charges.

    Part C

    • Medicare Part C, also known as a Medicare Advantage Plan, is an alternative to have Part A and B coverage. You buy a Part C plan from a Medicare-approved insurance company. Each plan can set its own rules for deductibles and coinsurance.

    Part D

    • Medicare Part D, also known as a Prescription Drug Plan, generally has an annual deductible that varies based on the plan you buy.

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