Does Original Medicare have a maximum out-of-pocket limit?
The short answer
Original Medicare does not have a maximum out-of-pocket limit, which means your costs could keep growing if you have a serious illness or long hospital stay.
The full explanation
This is one of the most important things to understand about Original Medicare, and it surprises a lot of people. Most insurance plans cap how much you pay in a given year. Once you hit that ceiling, the plan covers 100 percent. Original Medicare has no such ceiling.With Original Medicare, you pay a deductible when you're admitted to the hospital, and if your stay stretches past 60 days, you start paying a daily coinsurance amount that grows the longer you're there. On the Part B side, you generally pay 20 percent of most covered services with no cap. A serious cancer diagnosis or a major surgery could mean tens of thousands of dollars in out-of-pocket costs.That's the main reason most people add some form of extra coverage. A Medicare Supplement plan (also called Medigap) can cover most or all of those gaps. A Medicare Advantage plan (Part C) is required by law to have a yearly out-of-pocket maximum, though the specific limit varies by plan. Either approach gives you more financial predictability than Original Medicare alone. Verifying current plan details with a licensed agent is a smart step before you decide.
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