How Your Medical Benefits Work: What Is A Deductible? 

A deductible is a set amount you pay for your health care before your medical plan starts to pay. Once you reach the deductible, you pay a copayment or coinsurance for services covered by your medical plan, and the plan pays for the rest. Generally, the higher the deductible, the lower your premium, and vice-versa. For example, a plan with a $0 deductible may have a higher monthly premium than a plan with a $100 deductible.

The Medicare Part B annual deductible for 2025 is $257. If you are enrolled in the HOP Medical Plan, you are responsible for $50 of that deductible, and the plan pays the rest. The deductible for the Value Medical Plan is $257. If you are enrolled in a Medicare Advantage Plan, call the insurance company phone number on the back of your ID card for your deductible amount.

How It Works

As you incur and pay for medical expenses out of your pocket, the amount you spend counts toward the deductible. Until you reach the deductible, you are responsible for paying 100% of the services covered by your medical plan. Once your out-of-pocket costs reach the deductible amount, your benefit plan will kick in and begin sharing the cost of covered services with you.

For example, the HOP Medical Plan has a $50 deductible. Members enrolled in this plan pay $50 out of their pocket for expenses that are subject to the deductible. Some preventive care services (e.g., annual wellness exams) are excluded from the deductible and covered 100%. After the $50 deductible is met, members share the cost with the Plan through coinsurance or copayments.

Other facts you need to know about deductibles:

• Some health plans do not have deductibles.
• The deductible can change from year to year.
• The deductible resets at the start of every calendar year.
• Your out-of-pocket costs count toward the deductible.