Does Medicare have an out-of-pocket spending maximum?

Original Medicare, which includes Part A and Part B, doesn’t limit what you pay in cost sharing, but Medicare Advantage plans that you purchase from private insurers do. Depending on your health, out-of-pocket expenses can add up quickly. The good news is you have options for assistance in paying your share of the bills.

Many people with original Medicare buy a Medicare supplement policy, also known as Medigap, to cover most of these expenses. Others help fill in the gaps with their retiree health insurance, Tricare for Life military retirement insurance or other coverage.

What out-of-pocket costs do I have with Medicare?

Even though Medicare covers many of your medical expenses after you turn 65, you still need to pay some costs yourself.

Medicare Part A pays for a portion of inpatient stays in hospitals and skilled nursing facilities. You can expect to pay:

• A $1,632 deductible for each benefit period you’re hospitalized in 2024.

• A portion of hospital costs if you stay more than 60 days: $408 a day for days 61 to 90, and an $816 daily copay after day 90 for up to 60 lifetime reserve days in 2024. You’re responsible for all costs if you use up your lifetime reserve days.

• A $204 daily copay if you stay in a skilled nursing facility for 21 to 100 days. You’re responsible for all costs beyond day 100. 

Medicare Part B covers physician services, outpatient care and durable medical equipment but also has out-of-pocket expenses. You can expect to pay:

• A $240 deductible in 2024.

• A 20 percent coinsurance to cover most Part B services.

However, many preventive services have no cost sharing.

Does Medicare Advantage have out-of-pocket limits?

Yes. Federal law requires Medicare Advantage plans to have an out-of-pocket limit of $8,850 or less for covered in-network services in 2024, and $13,300 or less for covered in-network and out-of-network services combined. Some plans have lower limits.

Medicare Advantage plans must provide at least the same coverage as Medicare Part A and Part B, but they can have different cost-sharing amounts. Out-of-pocket limits apply to deductibles, copayments and coinsurance you pay for expenses covered by Part A and Part B but not for additional coverage, such as dental, hearing or vision benefits. The out-of-pocket maximum also doesn’t include your premiums.

Use the Medicare Plan Finder to find limits for plans in your area. After you pay the out-of-pocket maximum in deductibles, copays and coinsurance, your plan pays 100 percent for covered services.