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How Much Out of Pocket Cost Do You Pay With Medicare?



The Original Medicare Part A and B do NOT have an out of pocket limit. So to keep it simple, you are responsible for a share of your health care costs with Medicare regardless of the amount.


Out of Pocket Costs With Original Medicare.


There are various different types of out of pocket costs with original Medicare. It’s important to understand some basic information about these costs when choosing your Medicare Insurance plan. Provided below are some of the most important things to keep in mind:


  • Everyone has to pay a monthly Medicare Part B premium, however Medicare Part A is premium free for most of the people.

  • With original Medicare you have to pay Part A and Part B deductibles.

  • With original Medicare you have to pay 20% of the Medicare approved amount for Part B covered services.

  • With Medicare Part A you are responsible for per day co-payments after a 60 day period in the hospital in one benefit period.

  • In Medicare Part A you are responsible for a per day copayment after a 20 day period in a skilled nursing facility (the first 20 days is $0)..

  • Medicare Part A also requires that you make co-payments for some types of medications during hospice care.


One option to help pay the out-of-pocket expenses of original Medicare is to purchase additional coverage with a Medicare Supplement Plan. Medicare Supplement Plans are offered by private insurance companies that are currently under contract with Medicare. Although the coverage that is offered is standardized, the premiums may vary.


Is There an Annual Out of Pocket Maximum for The Medicare Advantage Plans?


Yes, unlike original Medicare, all Medicare Advantage plans have a limit on out of pocket costs. This is one significant benefit of enrolling in a Medicare Advantage Plan.


Medicare Advantage Plans can simply be seen as an alternate way to get original Medicare. Most of these plans include drug coverage and other benefits that may not be provided by original Medicare such as hearing, vision, and dental care.


Medicare has set a maximum limit for out of pocket costs for all Medicare Advantage plans. Each Medicare Advantage Plan may set its own limit, as long as it does not exceed the limit provided by Medicare. It is also important to know that only out of pocket costs related to Medicare-covered services count towards the limit.


To keep it simple, all Medicare Advantage Plans offer a certain level of financial protection against high out of pocket health care costs.


We are Independent Insurance Brokers, and have been appointed by many of the major insurance carriers. We can help you find the best policy for your individual situation. We work with clients in Winchester, VA, Martinsburg, WV, and Charles Town, WV.

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