Medicare premiums keep coverage active. Deductibles, coinsurance, and copayments determine what you pay when you use that coverage.

What Is a Deductible?

A deductible is the amount you pay before Medicare or your plan begins sharing certain covered costs.

Part A uses a deductible for each benefit period, not one deductible for the entire calendar year. Part B has an annual deductible. Medicare Advantage and Part D deductibles vary by plan.

In 2026, the Part A hospital deductible is $1,736 per benefit period, and the Part B annual deductible is $283.

What Is Coinsurance?

Coinsurance is often a percentage of the approved cost that you pay after meeting any applicable deductible.

Under Original Medicare Part B, you commonly pay 20% of the Medicare-approved amount for covered services when the provider accepts that amount as full payment. This is called accepting assignment. If the approved amount is $100, your coinsurance would generally be $20 after the deductible.

Part A also uses daily coinsurance for longer hospital and skilled nursing facility stays.

What Is a Copayment?

A copayment is usually a fixed amount. A Medicare Advantage plan might charge one copayment for a primary care visit and another for a specialist, urgent care, or hospital stay. Part D plans commonly charge fixed copayments for certain drug tiers.

Why the Medicare-Approved Amount Matters

With Original Medicare, your share is generally based on the Medicare-approved amount rather than the provider’s usual price. This applies when the provider accepts assignment.

A non-participating provider may sometimes charge more than the approved amount. An opt-out provider can require a private contract, and Medicare usually will not pay.

How to Estimate Your Cost

Before care, ask:

  • Has my deductible been met?
  • Is the provider in-network or accepting assignment?
  • Is the charge a copayment or percentage coinsurance?
  • Do I need the plan’s approval before care, called prior authorization?
  • Is there a separate facility charge?
  • Does the amount count toward an annual out-of-pocket limit?

Original Medicare has no annual out-of-pocket maximum by itself. Medicare Advantage plans have a yearly limit for covered Part A and Part B services, but Part D drug costs follow separate rules.

A plan with a $30 copayment would charge that fixed amount instead of a percentage under that benefit. These amounts are examples, not quotes. Some preventive services do not require you to meet a deductible, so ask how your specific service is billed.

Medicare policy sources last checked: October 8, 2026.