Out-of-pocket costs are the amounts people must pay for care and services when Medicare does not fully cover those services.

Medicare Advantage

Medicare Advantage plans have an annual out-of-pocket limit. This limit applies to services covered under Part A (inpatient hospital care) and Part B (outpatient medical care). It does not include the cost of Part D (prescription drugs).

Once a person reaches their plan’s deductible maximum, they will not have to pay any more for these types of services for the rest of the year. The deductible maximum may vary by plan, as private insurance companies offer Medicare Advantage plans. However, the deductible cost cannot exceed the maximum set by Medicare.

The deductible limits for Medicare Advantage plans in 2024 are as follows:

• USD 8,850 for in-network services
• $13,300 for off-network and on-network services combined

Medigap

Medigap, or Medicare Supplement Insurance, is supplemental insurance that people can purchase from private insurance companies. Medigap coverage can help pay a person’s share of Original Medicare costs.

Medigap is only available to people who have Original Medicare plans.

Medigap premiums and deductibles can vary depending on where you live and your insurer, but some Medigap plans set a deductible limit each year.

The two Medigap plans that set out-of-pocket limits are Plan K and Plan L. The maximum out-of-pocket limits for these plans in 2024 are as follows:

• Plan K: $7,060
• Plan L: $3,530

Read more about comparing Original Medicare and Medicare Advantage.

Under the cost-sharing system, a person pays a certain amount of the cost of care and services, and Medicare covers the rest.

Shared costs include copayments, deductibles, and deductibles. For example, if a person meets their Part B deductible, they are responsible for 20% of the cost of care and services.

In general, Medicare covers about 80% of the cost of approved services.

The out-of-pocket limits for Medicare Advantage and Medigap plans mean that once a person reaches that amount, they are no longer responsible for paying for any portion of their care and services. For the remainder of the year, Medicare will cover 100% of the costs.

Medicare premiums and deductibles can change each year. The cost of Medicare Advantage and Medigap plans also varies by location, coverage, and insurance provider.

The following table provides an overview of Medicare costs for 2024:

The Medicare search tool allows users to search for health and drug plans in their area.

Medicare sets an annual out-of-pocket limit for Medicare Advantage and Medigap plans. This is the maximum amount a person is allowed to spend out of pocket for care and services, including deductibles, copayments, and co-payments.

Once a person reaches this deductible limit, he or she is no longer responsible for paying for any portion of Medicare-approved services for the remainder of the year.

Deductible costs vary by location and plan.