Chelsey Tucker graduated with a Bachelor of History degree from Metropolitan State University in 2019. She now writes about insurance with her specialty being life insurance and has been quoted on Help Smart Phone and MEL Magazine.

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Dan Walker graduated with a BS in Administrative Management in 2005 and has been working in his family’s insurance agency, FCI Agency, for 15 years. He is licensed as an agent to write property and casualty insurance, including home, auto, umbrella, and dwelling fire insurance. He’s also been featured on sites like Reviews.com.

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Reviewed by Daniel Walker
Licensed Auto Insurance Agent

UPDATED: Jan 4, 2022

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The Lowdown

  • Medicare Part A and B don’t have out-of-pocket maximums
  • Private insurers under Part C all have a set out-of-pocket maximum
  • According to a non-profit, Medicare patients spent $5,460 a year on out-of-pocket costs

What is the maximum out-of-pocket expense with Medicare? For traditional Medicare health insurance coverage, there aren’t many out-pocket maximums. However, Part C through private insurers does have a set out-of-pocket maximum.

While you’re researching the maximum out-of-pocket expense with Medicare, enter your ZIP code into our free quote tool to get an idea of what you could pay.

What are Medicare out-of-pocket expenses?

When you’re enrolled in the Medicare health insurance program, you’ll still be responsible for some of the costs for your visit.

These costs are referred to as out-of-pocket expenses. These expenses add up to your out-of-pocket maximum, which is the amount when your insurer takes on the total cost.

How do the Medicare Parts dictate out-of-pocket expenses?

Medicare is split up into multiple Parts to simplify coverage and make processing claims easier. Each Part of Medicare has its own rules about out-of-pocket maximums.

According to the official Medicare.gov site, these include:

  • Part A: This is for any inpatient hospital stays. No out-of-pocket maximum, and there is no monthly premium for most people.
  • Part B: Outpatient doctor’s visits and some medical equipment. There is also no out-of-pocket maximum.
  • Part C: This is private insurance through Medicare, so everything but the Medicare Advantage out-of-pocket expenses maximum is left to the insurer.
  • Part D: Part D covers many prescription drugs or vaccinations and will reach an out-of-pocket maximum when you hit the “catastrophic coverage” amount.

While there is no out-of-pocket maximum for Parts A and B, there are still limits on what Medicare will cover with those services.

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What counts towards the out-of-pocket maximum with Medicare Advantage?

Your out-of-pocket costs are what you pay that the insurance company doesn’t reimburse. Some of these costs include:

  • Coinsurance
  • Deductibles
  • Copayments

In a more detailed explanation, your out-of-pocket costs are your share of the costs for medical treatments. Once you meet your out-of-pocket maximum, your insurance company begins taking over the costs of all your medical treatment for the rest of the benefit year.

How much do Medicare recipients have to pay out-of-pocket per year?

A non-profit organization called the Kaiser Family Foundation researched this topic. It found that Medicare recipients paid over $5,460 out-of-pocket in 2016 on:

  • Premiums
  • Deductibles
  • Coinsurance
  • Copayments

While these costs might seem like a lot, it’s more affordable than senior coverage at a traditional insurer and even more so than paying for treatment outright.

The out-of-pocket maximum with a Medicare Advantage plan (Part C) is set at $7,550, but can change each year.

That is the most that you can pay if you have an Advantage plan, regardless of your medical costs.

What should I know about Medicare costs?

The official Medicare site offers some insight into the costs that a patient can expect from traditional Medicare. These costs include a $1,484 deductible, after which you have a $0 coinsurance for your first 60 days in the hospital.

For outpatient care, you can expect to pay a monthly premium of around $170 in 2022. For Medicare Part B, you have a $233 deductible. After you meet this deductible, you pay 20% of the approved amount.

As previously mentioned, Part C premiums vary between private insures. Part C also varies depending on which drug plan you choose.

How can I save on my Medicare expenses?

Everyone goes through hard times. To that end, you can find help getting more affordable medical costs and coverage through Medicare or other government programs. Some of these options include:

  • Extra Help – To help cover costs, this plan helps pay for Part D, such as the premiums and expenses when you fill your prescriptions.
  • Medicare savings programs – Medicare offers four separate programs to help you save on your premiums. Programs vary by state.
  • Medicaid – Depending on your state’s expansion, you may qualify for more healthcare savings through Medicaid, which is specifically designed to help low-income individuals.

How do poor people get health insurance? With these openly advertised programs, you can get some form of help paying for your health insurance costs.

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Medicare Out-of-Pocket Maximum: The Bottom Line

Now that you know there is no maximum out-of-pocket expense with Medicare in most cases, you can plan your finances accordingly. Considering most traditional Medicare patients pay upwards of $5,000 a year, you may want to consider additional savings options.

As you research the maximum out-of-pocket expenses with Medicare, enter your ZIP code into our free quote tool to see what you could pay at a private insurer.