Medicare 2026

The $283 Part B Deductible in 2026: When It Applies and Which Services Skip It

If you have Original Medicare, one of the first out-of-pocket costs you'll run into each year is the Part B deductible. For 2026 it is $283, up from $257 in 2025. You pay it once per calendar year before Medicare begins paying its share of your covered outpatient care. After that, you typically owe 20 percent of the Medicare-approved amount for most services, as long as your provider accepts assignment.

That's the short version. The longer version is more interesting, because not every service runs through the deductible, and knowing which ones don't can help you plan.

How the deductible actually works

Think of the deductible as a yearly threshold you cross once. Until you meet it, you're responsible for the full Medicare-approved amount of your Part B services. Once you've paid $283 in applicable costs during 2026, Medicare begins covering its usual 80 percent, and you pay the remaining 20 percent for most outpatient care — doctor visits, outpatient procedures, mental health services, and so on — provided your doctor accepts assignment.

A quick note on "assignment": a provider who accepts assignment agrees to take the Medicare-approved amount as full payment. That protects you from being billed above the approved rate for the Medicare-covered portion.

Services where the deductible does NOT apply

Several categories of care are specifically designed so that cost isn't a barrier. Under Original Medicare:

• The "Welcome to Medicare" preventive visit is $0 and the Part B deductible does not apply, as long as the provider accepts assignment. This is a one-time visit available during your first 12 months with Part B.
• The yearly "Wellness" visit is also $0 with no deductible, again when the provider accepts assignment.
• Covered clinical laboratory services — things like blood tests your doctor orders — are $0 under Original Medicare.
• Covered home health care services are $0 under Original Medicare. (Durable medical equipment ordered as part of home health is a separate story: you pay 20 percent of the Medicare-approved amount for DME.)

One caveat on the preventive and wellness visits: if your doctor performs or orders additional tests or services during the same appointment that fall outside the preventive benefit, the deductible and coinsurance can apply to those added services. It's worth asking at the visit, "Is anything we're doing today billed separately?"

Screening colonoscopies and polyp removal

Screening colonoscopies are preventive, but historically if a polyp was found and removed, the visit was reclassified in a way that triggered cost-sharing. Federal rules have been phasing that out. For 2026, if a polyp or other tissue is removed during a screening colonoscopy, the Part B deductible does not apply, and your coinsurance is 15 percent of the Medicare-approved amount. The rules set Medicare's share higher in future years — 90 percent for 2027 through 2029 (so a 10 percent coinsurance for you) and 100 percent starting January 1, 2030.

Federally Qualified Health Centers

At a Federally Qualified Health Center (FQHC), the Part B deductible doesn't apply. You usually pay 20 percent of the charges or the Medicare-approved amount, and most preventive services are $0. If you receive primary care at an FQHC, this can noticeably simplify your out-of-pocket math.

Medigap and the deductible

If you have a Medigap policy, some plans help with the Part B deductible — but the list is short. Only Medigap Plans C and F pay the Part B deductible. And because of a federal change, people who became eligible for Medicare on or after January 1, 2020 cannot buy Plans C or F. If you were already eligible before that date, you may still be able to purchase or keep those plans.

Original Medicare vs. Medicare Advantage, neutrally

The deductible discussion above applies to Original Medicare (Parts A and B), often paired with a stand-alone Part D drug plan and sometimes a Medigap policy. Medicare Advantage (Part C) plans are an alternative that bundle Part A and B coverage, usually with drug coverage, through a private plan with its own cost structure, networks, and rules.

Neither path is universally "better." Original Medicare with a Medigap policy tends to offer broad provider access and more predictable cost-sharing, but Medigap premiums add to your monthly budget. Medicare Advantage often has lower monthly premiums and may include extras, but it uses networks and prior authorization, and your out-of-pocket costs can vary by service. The right fit depends on your health, providers, budget, and preferences.

A few dates and numbers worth keeping in view

• Annual Enrollment for 2027 coverage runs October 15 – December 7, 2026; changes take effect January 1, 2027.
• The Part D out-of-pocket cap is $2,100 in 2026 and $2,400 in 2027. No Part D plan may charge a deductible higher than $700 in 2027. The Part D base beneficiary premium for 2027 is $41.33, which is used to calculate the late-enrollment penalty; actual plan premiums are set plan by plan.
• Social Security announced a 3.6 percent COLA for benefits payable beginning January 2027.
• The 2027 Part B standard premium and deductible and the 2027 IRMAA income brackets have not yet been released. CMS announces these in the fall, usually in November.

If you have Medicaid or Extra Help

Since 2025, people with Medicaid or Extra Help have a monthly Special Enrollment Period to move to Original Medicare with a stand-alone Part D plan, or to switch stand-alone Part D plans. Full-benefit dual-eligible individuals can also join an integrated D-SNP in any month.

Where to get answers

For official information on costs, coverage rules, and enrollment, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227), available 24 hours a day, 7 days a week. TTY users can call 1-877-486-2048. This article is educational only; it is not from or affiliated with any government agency.