Medicare Out Of Pocket Costs
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 2022, the deductible for Medicare Part A is $1,556 per benefit period, and the deductible for Medicare Part B is $233 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 2022, your Medicare Part A coinsurance for inpatient hospital care is as follows:
- Days 1-60: $0 coinsurance for each benefit period
- Days 61-90: $389 coinsurance per day of each benefit period
- Days 91 and beyond: $778 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.
Important: Plan F and Plan C are not available to beneficiaries who became eligible for Medicare on or after January 1, 2020.
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
Learn more about Medicare coverage of common procedures
Refer to the chart below to see how each type of Medigap plan compares
Scroll to the right to continue reading the chart
Medicare Supplement Benefits
Part A coinsurance and hospital coverage
Part B coinsurance or copayment
Part A hospice care coinsurance or copayment
First 3 pints of blood
Skilled nursing facility coinsurance
Part A deductible
Part B deductible
Part B excess charges
Foreign travel emergency
|Medicare Supplement Benefits||A||B||C*||D||F1*||G1||K2||L3||M||N4|
|Part A coinsurance and hospital coverage|
|Part B coinsurance or copayment||50%||75%|
|Part A hospice care coinsurance or copayment||50%||75%|
|First 3 pints of blood||50%||75%|
|Skilled nursing facility coinsurance||50%||75%|
|Part A deductible||50%||75%||50%|
|Part B deductible|
|Part B excess charges|
|Foreign travel emergency||80%||80%||80%||80%||80%||80%|
* Plan F and Plan C are not available to Medicare beneficiaries who became eligible for Medicare on or after January 1, 2020. If you became eligible for Medicare before 2020, you may still be able to enroll in Plan F or Plan C as long as they are available in your area.+ Read more
1 Plans F and G offer high-deductible plans that each have an annual deductible of $2,490 in 2022. Once the annual deductible is met, the plan pays 100% of covered services for the rest of the year. The high-deductible Plan F is not available to new beneficiaries who became eligible for Medicare on or after January 1, 2020.
2 Plan K has an out-of-pocket yearly limit of $6,620 in 2022. After you pay the out-of-pocket yearly limit and yearly Part B deductible, it pays 100% of covered services for the rest of the calendar year.
3 Plan L has an out-of-pocket yearly limit of $3,310 in 2022. After you pay the out-of-pocket yearly limit and yearly Part B deductible, it pays 100% of covered services for the rest of the calendar year.
4 Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to $50 copayment for emergency room visits that don’t result in an inpatient admission.- Read less
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 1-800-995-4219, or read through our guide, 10 Medicare Mistake You Could Be Making to learn more.
Compare Medigap plans in your area.Find a plan
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