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Medicare Out Of Pocket

Original Medicare (Part A and Part B) is the federal health insurance program for people age 65 and older and individuals with certain disabilities. Although Original Medicare provides comprehensive coverage, it still leaves some out-of-pocket costs to recipients.

To limit how much you’ll likely pay out of pocket for medical and hospital care, you may consider enrolling in a Medicare Supplement Insurance (Medigap) plan.

Common Out-of-Pocket Costs

Some of the out-of-pocket costs you can expect to pay with Original Medicare include deductibles, copayments and coinsurance. 


A deductible is the amount you must pay for covered medical expenses before Medicare pays its share. In 2019, the deductible for Medicare Part A is $1,364 per benefit period, and the deductible for Medicare Part B is $185 per year.


Coinsurance is the percentage of costs you pay for health care expenses after your deductible is met. In most cases, your Medicare Part B coinsurance is 20 percent of the cost of Medicare-approved services. In 2019, your Medicare Part A coinsurance for inpatient hospital care is as follows:

  • Days 1-60: $0 coinsurance for each benefit period
  • Days 61-90: $341 coinsurance per day of each benefit period
  • Days 91 and beyond: $682 coinsurance per each lifetime reserve day after day 90 for each benefit period (you have up to 60 reserve days over your lifetime)


A copayment is the fixed dollar amount you pay for specific health care services after you’ve met your deductible.

Covering Some of Your Out-of-Pocket Expenses

Medicare Supplement Insurance provides full or partial coverage for some of the out-of-pocket expenses listed above. There are currently 10 standardized Medigap plans available in most states, and each includes a unique blend of basic benefits. 

All 10 standardized Medigap plans provide at least partial coverage for:

  • Medicare Part A coinsurance and hospital costs
  • Medicare Part B coinsurance or copayment
  • First three pints of blood
  • Medicare Part A hospice care coinsurance or copayment

Refer to the chart below to see how each type of Medigap plan compares

Chart showing Medigap plan benefits in 2019

Connect With a Licensed Agent

Ultimately, the right Medicare Supplement Insurance plan for you depends on your specific health care needs and anticipated out-of-pocket Medicare costs. A licensed agent can help explore your options and match you with a Medigap policy that works for you.

Contact an agent today at --ms-tfn-- , or read through our guide, 10 Medicare Mistake You Could Be Making to learn more. 

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Resource Center

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