Costs
Deductible
Quick answer
A deductible is the amount you pay out of pocket for covered services before your plan starts to pay. Part A, Part B, Part D, and many Medicare Advantage plans each have their own deductibles.
Plain-English definition
Deductibles usually reset each calendar year (Part B and Part D) or each benefit period (Part A).
Why it matters
A higher deductible often means a lower premium, and vice versa.
A simple example
Your plan has a $250 drug deductible. You pay the first $250 of drug costs, then copays kick in.
Common mistakes & misconceptions
Related terms
Copay
A copay (copayment) is a fixed dollar amount you pay for a covered service, like $10 for a primary-care visit or $47 for a Tier 3 drug.
Coinsurance
Coinsurance is your share of a covered service as a percentage, not a fixed dollar amount. Original Medicare's Part B coinsurance is 20% after the deductible.
MOOP (Maximum Out-of-Pocket)
MOOP stands for Maximum Out-of-Pocket. It's the yearly cap on what you pay for covered in-network medical services in a Medicare Advantage plan. Once you hit it, the plan pays 100% of covered Part A and Part B care for the rest of the calendar year.
Medicare Part A
Medicare Part A is hospital insurance. It covers inpatient hospital stays, skilled nursing facility care after a qualifying stay, home health care, and hospice. Most people get Part A premium-free at 65.
Medicare Part B
Medicare Part B is the medical insurance half of Original Medicare. It covers doctor visits, outpatient care, preventive screenings, mental health services, and durable medical equipment.
Frequently asked questions
Does the deductible reset each year?+
Part B and Part D deductibles reset every January 1.
Sources & references
📚 Where this information comes from
- Medicare.gov — official U.S. government site for people with Medicare ↗Primary source for benefits, enrollment periods, and plan comparison.
- CMS.gov — Centers for Medicare & Medicaid Services ↗Federal rulemaking, program updates, and official guidance.
- Social Security Administration — Medicare enrollment & premiums ↗Enrollment, premium withholding, and IRMAA determinations.
When you're ready, compare plans on your own terms
See Medicare Advantage plans from the insurance companies we represent, or walk the course with a licensed agent whenever you'd like a second set of eyes.
We help compare Medicare Advantage plans from the insurance companies we represent, and we don't offer every plan available in your area.
Medicare Caddies is an independent insurance agency. We are not affiliated with, endorsed by, or connected to the U.S. government, the federal Medicare program, or the Centers for Medicare & Medicaid Services (CMS). We help compare Medicare Advantage plans from the insurance companies we represent, and we don't offer every plan available in your area.