Does Medicare Have an Out-of-Pocket Spending Limit? – Frequently Asked Questions

Victoria Burke by Victoria Burke | Licensed since 2011
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This article was updated on: 10/29/2018

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Out-of-pocket limits and Original Medicare insurance

Original Medicare, Part A (hospital insurance) and Part B (medical insurance), generally covers most out-of-pocket medical expenses. However, Part A and Part B do not have out-of-pocket limits on the amount you spend. That means that if you’re hospitalized many times or for a long time within a year, you could end up with substantial medical bills.

Out-of-pocket limits and Medicare Supplement insurance

Medicare Supplement insurance, available from private health insurance companies, may help with Medicare’s out-of-pocket costs. Medicare Supplement (Medigap) plans are designed to work alongside your Medicare Part A and Part B coverage – you need to be enrolled in both Part A and Part B to buy a Medicare Supplement plan.

Most states have up to 10 standardized Medicare Supplement plans available that might help with Medicare out-of-pocket costs. Some plans also include additional benefits, beyond helping with Medicare out-of-pocket costs. Two plans, Plan K and Plan L, have out-of-pocket spending limits.

Each standardized Medicare Supplement plan may cover your inpatient hospital costs and coinsurance for an extra 365 days after your Medicare benefits are used up. And each of these standardized plans may also cover at least part of your Medicare Part B coinsurance payments and copayments. Read more about what each standardized Medicare Supplement plan offers when it comes to helping with your Medicare out-of-pocket costs.

Out-of-pocket limits and Medicare Advantage

The Medicare Advantage (Medicare Part C) program offers an alternative way to get your Medicare Part A and Part B benefits through a private insurance company approved by Medicare. Unlike Original Medicare, Part A and Part B, Medicare Advantage plans each have an annual out-of-pocket limit on your spending. This amount can change every year. You must keep paying your monthly Part B premium, along with any premium the plan may charge.

Out-of-pocket limits and Medicare Prescription Drug Plans

Medicare prescription drug coverage under Part D is optional. It’s available from private, Medicare-approved insurance company, either as a stand-alone Medicare Prescription Drug Plan or as part of a Medicare Advantage plan. If you sign up for a Medicare Prescription Drug Plan, there are certain protections against unlimited out-of-pocket spending. Read about the Part D coverage gap and how it can protect you if you spend a lot of money on your medications each year.

Want to know more about the different Medicare plan options that might help with your Medicare out-of-pocket expenses? I’d be glad to help you.

  • You can set up an appointment to talk by phone about your needs, or ask me to email you some customized Medicare plan options. Use the links below.
  • Want to look at plan options anytime on your own with no obligation? Just click the Compare Plans or Find Plans buttons on this page.

The product and service descriptions, if any, provided on these Medicare.com Web pages are not intended to constitute offers to sell or solicitations in connection with any product or service. All products are not available in all areas and are subject to applicable laws, rules, and regulations.

Medicare has neither reviewed nor endorsed this information.

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