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Medicare Out Of Pocket

Christian Worstell

by Christian Worstell | Published April 26, 2021 | Reviewed by John Krahnert

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. 

Deductible

A deductible is the amount you must pay for covered medical expenses before Medicare pays its share. In 2021, the deductible for Medicare Part A is $1,484 per benefit period, and the deductible for Medicare Part B is $203 per year.

Coinsurance

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 2021, your Medicare Part A coinsurance for inpatient hospital care is as follows:

  • Days 1-60: $0 coinsurance for each benefit period
  • Days 61-90: $371 coinsurance per day of each benefit period
  • Days 91 and beyond: $742 coinsurance per each lifetime reserve day after day 90 for each benefit period (you have up to 60 reserve days over your lifetime)

Copayment

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

Click here to view enlarged chart

Scroll to the right to continue reading the chart

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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.

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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.

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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. 

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