![]() Medicare Part A does not offer the protection of an out-of-pocket maximum.Ībout 99 percent of people don’t have to pay a Part A monthly premium. Inpatient care you receive after being admitted into a hospital (excluding emergency room care). ![]() Medicare Part A is the part of Original Medicare that pays for inpatient services. These include the Medicare Part B monthly premium you still are responsible for as well as your Part C monthly premium (if any). Monthly premiums are another expenditure that won’t go towards meeting your Medicare out-of-pocket maximum. Neither will uncovered services your plan doesn’t cover. If your Medicare Advantage plan includes Part D (prescription drug) coverage, the cost of your medications will not go towards your out-of-pocket maximum. Once you reach this dollar figure, your plan will pay 100% for all your covered healthcare costs for the remainder of the plan period. Your deductibles, copays and coinsurance all go towards your Medicare out-of-pocket maximum. It is the highest amount of money you will have to pay for covered healthcare services within a plan year. In healthcare, an out-of-pocket maximum is also referred to as an out-of-pocket limit. So, just what is the Medicare out-of-pocket maximum ? If you’re concerned about the cost of healthcare, the Medicare out-of-pocket limit is an important dollar figure for you to know about. That’s a scary reality we hope won’t happen to you, but life is unpredictable. Let’s face it, higher-than-expected medical bills can happen to anyone, even those in perfect health. ![]() What is the Medicare out-of-pocket maximum ? For that reason, Medicare Advantage PPO plans list one out-of-pocket maximum amount for in-network services, and one out-of-pocket maximum amount that combines in-network and out-of-network healthcare costs. Both types have provider networks, but PPO plans typically pay a percentage of your healthcare costs when you see an out-of-network provider. There are several different types of Part C plans, including HMOs (Health Maintenance Organizations) and PPOs (Preferred Provider Organizations). The Medicare out-of-pocket maximum for Part C plans is established by the insurer that manages the plan. Part C plans are sold by Medicare-approved private insurers for this purpose. Many Part C plans also offer lower out-of-pocket limits of $6,000 or less. For in-network services in 2021, the highest Medicare out-of-pocket maximum a Part C plan could allow was $7,550. This means there is an automatic limit on the amount of money you will spend for covered healthcare during any given year. Unlike Original Medicare, Part C plans are required to have out-of-pocket maximums. Medicare Advantage plans are an alternative way to get full Medicare coverage. Instead of Original Medicare you may have, or be interested in getting, a Medicare Advantage (Part C) plan. If you have Original Medicare, there’s no ceiling on the amount of money you may have to pay for covered inpatient or outpatient services. Original Medicare consists of two parts - Part A and Part B. Many people are surprised to learn that Original Medicare doesn’t have out-of-pocket maximums.
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