Medicare coverage5 important points about Medicare Part A and Part B coverage gaps
There are 3 primary out-of-pocket costs you’ll want to consider as you begin evaluating Medicare plans:
- Copays—A fixed amount ($20, for example) you pay for a covered healthcare service after you've paid your deductible
- Coinsurance—The percentage of costs of a covered healthcare service you pay (20%, for example) after you've paid your deductible
- Deductibles—The amount you pay for covered healthcare services before your insurance plan starts to pay.
Let’s take a look at deductibles. Medicare plans have deductibles just like individual or employer health insurance plans do. Both Original Medicare and, typically, Medicare Advantage Plans, require you to meet a deductible—an amount you pay for healthcare or for prescriptions—before your healthcare plan begins to pay.
Medicare Part A, the hospital insurance program, and Medicare Part B, which covers doctor services, among other things, both have a deductible, which is 1 type of out-of-pocket cost members may have to pay.
Medicare Advantage plans, which may offer additional benefits, have different costs depending on the plan.
The deductibles listed below are for 2019 Original Medicare Part A and Part B.
Original Medicare requires that you pay a deductible for each inpatient hospital “benefit period,” which means you may have to pay a deductible more than once in a single year.
A benefit period begins the day you're admitted to a hospital or skilled nursing facility and ends when you haven't spent the night in one of them for 60 consecutive days. If you're admitted to a hospital or skilled nursing facility after one benefit period has ended, then a new one begins, and you’ll have to pay another deductible.
The 2019 Medicare Part A deductible for each benefit period is $1,364—which may sound like a lot, but it’s less than the average cost of a single night in a U.S. hospital.1
Medicare Part B deductible
Medicare Part B covers most doctor services, including those you receive while hospitalized, as well as outpatient therapy and the rental or purchase of durable medical equipment, which is equipment your doctor prescribes because it is medically necessary, like blood sugar monitor test strips, walkers or wheelchairs.
The total 2019 Part B deductible is $185 for the year. No benefit periods apply to Part B coverage.
Medicare Supplement (Medigap) insurance may help cover deductibles
You can buy private Medicare Supplement insurance to cover Medicare’s out-of-pocket expenses, including the hospital deductible.
However, if you're in a Medicare Advantage Plan, you can only purchase a Medicare Supplement plan if your Medicare Advantage plan coverage is ending.
- Emily Rappleye, “Average Cost per Inpatient Day Across 50 states,” Becker’s Hospital CFO Report, last accessed May 10, 2019, , opens new window.
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