Does Original Medicare require a yearly out-of-pocket maximum?

Does Original Medicare require a yearly out-of-pocket maximum?

• A. No; Original Medicare does not have a single-year cap on out-of-pocket costs; MA plans do.
• B. Yes, Original Medicare has a universal out-of-pocket maximum every year.
• C. Only for hospital costs; outpatient costs are uncapped.
• D. It depends on the state you reside in.

Answer: (A)

Original Medicare (Part A and Part B) does not impose a yearly out-of-pocket maximum. You’ll have cost-sharing in the form of deductibles and coinsurance: Part A has a deductible per hospital benefit period and Part B has an annual deductible plus typically 20% coinsurance for many services. Because there’s no single annual cap, those costs can add up if you need extensive care. For protection against high annual costs, many people choose a Medicare Advantage plan (Part C), which must include an annual out-of-pocket maximum, and prescription drug plans (Part D) have their own drug cost maximums. So the statement that Original Medicare does not have a yearly cap is correct, while MA plans do have a cap.

Original Medicare (Part A and Part B) does not impose a yearly out-of-pocket maximum. You’ll have cost-sharing in the form of deductibles and coinsurance: Part A has a deductible per hospital benefit period and Part B has an annual deductible plus typically 20% coinsurance for many services. Because there’s no single annual cap, those costs can add up if you need extensive care. For protection against high annual costs, many people choose a Medicare Advantage plan (Part C), which must include an annual out-of-pocket maximum, and prescription drug plans (Part D) have their own drug cost maximums. So the statement that Original Medicare does not have a yearly cap is correct, while MA plans do have a cap.