If you’re new to Medicare, you might be surprised when you receive your first doctor’s bill for several hundred dollars. This is not a mistake. Medicare Part B does not kick in until you’ve satisfied your deductible. After that, your Medicare Part B coverage and Medicare supplement policy will cover your doctor visits, outpatient procedures, preventative services, lab work/diagnostics and even some approved medical equipment.
Let’s take a closer look at how a deductible works and how you can get the most from your coverage.
First, let’s start with some common terms.
A deductible is the amount you must pay out of pocket for covered healthcare services before your insurance plan starts to pay.
Your premium is the amount you pay for your health insurance coverage, typically on a monthly basis. It’s a regular, ongoing cost to maintain your insurance regardless of whether you use your benefits. Paying your premium ensures that you have active health insurance coverage.
Some plans require a copayment, or copay, which is a set amount you pay for specific healthcare services or medications when you use them. The copay is usually paid at the point of service, at the provider’s office or at your retail pharmacy.
Each year in October, the federal government establishes the Medicare Part B deductible for the following year. In 2023, it was $226; in 2024, it will go up to $240. That means that in January, if you see a doctor, you will be responsible for the first $240 before Medicare Part B will pay.
Creating a MyMedicare.gov account
A helpful resource for Medicare beneficiaries is the MyMedicare.gov website. There, you can create an account by entering your Medicare beneficiary ID number. This will give you access to all your Medicare claims details. You will be able to see a summary of what providers you saw, how much was billed, how much was paid, and whether you’ve met your Medicare Part B deductible. Medicare will also mail you a quarterly summary of your benefits, but the website will allow you to see this information in real time.
A word of caution: Before paying a doctor’s bill, be sure to check the status of your claims on MyMedicare.gov. If you see two doctors in one week before you’ve met your deductible, the first provider you saw will not necessarily be the first one to file the claim with Medicare. Refer to your Medicare summary notice to ensure your out-of-pocket amount is going to the correct provider.
Once you’ve met your Medicare Part B deductible for the year, you will not have any other out-of-pocket costs for doctor visits for the remainder of the year. Any additional costs will be covered by Medicare Part B. At the end of the year, the process resets, and you will again be responsible for the deductible in the following year.