The first Medicare remittance of the year is the one that confuses new billers and irritates experienced ones. A practice that saw 60 Medicare patients in the first week of January will post 60 claims in the third week, and most of them will show little or no payment. The allowed amount is there. The payment line says zero or close to it. The adjustment carries reason code PR-1, deductible amount. Nothing is wrong. The 2026 Medicare Part B deductible has reset, and the practice is now in the business of collecting it from patients or from their secondary coverage.
CMS announced the 2026 Part B figures on November 14, 2025, and published them in the Federal Register on November 19. The annual deductible is $283, up $26 from $257 in 2025. The standard monthly premium is $202.90, up from $185.00, an increase of just under 10 percent. Higher-income beneficiaries pay more through income-related adjustments, which do not affect your claims. The deductible does.
This article walks through how the $283 moves through a typical primary care practice in January: the remittance, the crossover to a Medigap or Medicaid secondary, the statement to the patient who has neither, and the front desk conversation. Most of it is the same every year. The number changes, and every January a few practices forget to update the number in the eligibility scripts and the estimate tool.
Key takeaways
- The 2026 Medicare Part B deductible is $283 per beneficiary per calendar year; the standard premium is $202.90 a month.
- Medicare applies the deductible to the allowed amount of the first claims it processes, which is not always the first date of service.
- Once met, the patient owes 20 percent coinsurance on most Part B services; Medigap, Medicaid or retiree plans often pick that up through crossover.
- Preventive services such as the annual wellness visit are exempt from the deductible, so a January AWV pays in full while the 99214 on the same day does not.
- Collecting the deductible depends on knowing whether it has been met before the patient arrives, which the HETS eligibility response tells you.
What changed for 2026 and where the numbers come from
Under the Social Security Act, CMS sets the Part B premium and deductible each fall based on projected program costs. The deductible has risen most years: it was $226 in 2023, $240 in 2024, $257 in 2025 and is $283 for 2026. CMS attributed the 2026 increase to projected price changes and utilization consistent with past trends. Part A figures moved too, with the inpatient hospital deductible at $1,736 for 2026, but Part A does not touch a physician practice's claims.
The one thing about the premium that matters to you: some patients will see a smaller Social Security check in January and will ask about it at the front desk. The hold-harmless rule limits the premium increase for some beneficiaries to the amount of their cost-of-living adjustment. Your staff do not need to explain that. They need a one-line answer: "The premium is set by Medicare, not by us, and it is separate from what you owe the practice." Then move on to the deductible, which is the part that involves your office.
How the deductible flows through a January remit
Medicare pays 80 percent of the allowed amount for most Part B services after the deductible is satisfied. Before it is satisfied, the allowed amount is applied to the deductible and the patient owes it. Take a fictional 71-year-old established patient seen January 5 for a 99214. Suppose the 2026 allowed amount in your locality is $128. Medicare has no other 2026 claims for this patient yet, so the entire $128 is applied to the deductible. The remit shows allowed $128, paid $0, and a PR-1 adjustment of $128. The patient now has $155 of deductible remaining.
She returns January 26 for a problem visit billed as 99213 with an allowed amount of $92. The remaining $155 of deductible absorbs all of it: paid $0, PR-1 of $92, and $63 remaining. Her third visit in February, another 99213 at $92, uses the last $63 of deductible and then Medicare pays 80 percent of the remaining $29, which is $23.20. The remit shows PR-1 of $63, PR-2 (coinsurance) of $5.80 and a payment of $23.20.
| Visit | Allowed | Applied to deductible (PR-1) | Coinsurance (PR-2) | Medicare pays | Deductible remaining |
|---|---|---|---|---|---|
| Jan 5, 99214 | $128.00 | $128.00 | $0.00 | $0.00 | $155.00 |
| Jan 26, 99213 | $92.00 | $92.00 | $0.00 | $0.00 | $63.00 |
| Feb 16, 99213 | $92.00 | $63.00 | $5.80 | $23.20 | $0.00 |
| Mar 9, 99214 | $128.00 | $0.00 | $25.60 | $102.40 | $0.00 |
Two wrinkles catch people. First, Medicare applies the deductible in the order claims are processed, not the order services were rendered. If a cardiologist's January 3 claim reaches the MAC after your January 5 claim, the deductible goes against yours. Second, the allowed amount, not your charge, is what counts. A practice that bills $210 for the 99214 still only collects $128 from the patient, and must write the difference off as CO-45 (charge exceeds fee schedule) exactly as if Medicare had paid.
Secondaries, crossovers and who actually pays the $283
Many Medicare patients do not pay the deductible themselves. Medigap Plan C and Plan F cover the Part B deductible in full for people who were eligible for Medicare before 2020; Plans G and N and the rest do not, so those patients owe it. Retiree plans vary. Medicaid pays the deductible for dual-eligible patients, subject to state payment rules that often mean the practice receives less than the full amount and must accept it. Medicare Advantage patients are not affected by any of this; their plans set their own cost sharing, and the $283 does not apply to them.
When Medicare has the secondary on file, the claim crosses over automatically after Medicare adjudicates, and the remit shows a crossover indicator (MA18 or a similar remark code). The secondary then pays the deductible and coinsurance under its own rules, usually within two to four weeks. When the crossover does not happen, because the secondary is not registered with Medicare's coordination of benefits contractor or the patient changed plans in January, the practice bills the secondary directly with the Medicare remit attached. January is when crossovers break, because supplement plans change at year end and the beneficiary's new plan is not yet linked.
Our operating rule: do not send the patient a statement for a PR-1 balance until the crossover has either paid or been confirmed absent. Statements for balances the Medigap plan is about to pay generate phone calls, refunds and irritated patients in roughly equal measure.
Collecting the deductible at the front desk
Whether to collect the deductible at the time of service is a policy decision, and practices land in different places. Collecting it is permissible for Medicare patients who have no secondary, provided you collect no more than the Medicare allowed amount and refund promptly if Medicare later applies less. What you cannot do is guess. The HETS eligibility response (the Medicare eligibility transaction available through your clearinghouse or the MAC portal) returns the remaining Part B deductible for the current year. Run it the day before the visit. If it shows $283 remaining and the patient has no supplement, the front desk knows the visit will be patient responsibility up to the allowed amount.
The script is short. "Your Medicare Part B deductible for 2026 is $283, and Medicare's records show none of it has been met yet. Today's visit will apply to it. Based on Medicare's allowed amount, your portion should be about $128. Would you like to pay that today, or would you prefer we bill you after Medicare processes the claim?" Give the choice. Most patients who understand why they owe it will pay it, and the ones who prefer a statement will not be surprised by the statement.
The exception to all of this is preventive care. The annual wellness visit (G0438 or G0439), the initial preventive physical examination (G0402), and most screening services are exempt from the deductible and coinsurance. A patient who comes in January for an AWV and a problem visit on the same day will see the G0439 paid in full and the 99214 with modifier 25 applied to the deductible. Explain that before the visit, not on the statement. If your front desk workflow for January does not already include the HETS check and a written estimate, the broader plan in our medical billing service pages covers what we set up for practices we bill for.
Questions we hear
Can we waive the Part B deductible for patients who cannot afford it?
Not routinely. Waiving Medicare cost sharing as a matter of course raises issues under the anti-kickback statute and the beneficiary inducement rules. A documented, individualized financial hardship determination is different, and a written hardship policy applied consistently is the usual approach. Ask counsel to review the policy before you use it.
The patient says another doctor already collected the deductible. Do we still apply it?
Medicare decides, not the practice. Check HETS the day of the visit; if the other claim has processed, the remaining deductible will show. If it has not processed yet, Medicare will apply the deductible to whichever claim arrives first, and one office will owe the patient a refund. Tell the patient that and refund promptly if it turns out to be you.
Why does our January cash drop every year even though visit volume is the same?
Because the deductible converts payer cash into patient cash for the first few weeks, and patient cash arrives more slowly and less completely. The fix is the estimate and time-of-service collection for patients without supplements, and a crossover check for those with them. Practices that do both see less of a January dip; the money does not disappear, it just changes who pays it.
What to do this week
- Update the deductible figure to $283 in your eligibility scripts, estimate templates and any patient handout about Medicare costs.
- Run HETS eligibility two business days ahead for every Medicare patient on the schedule and flag those with no secondary and an unmet deductible.
- Give the front desk the two-sentence script and a printed estimate based on the Medicare allowed amount for the scheduled visit type.
- Hold patient statements on PR-1 balances until the crossover has paid or been confirmed missing, then bill the secondary directly where needed.
- Confirm your posting rules write off the difference between charge and allowed as CO-45 on deductible claims, not to patient balance.
