Medicare Supplement Out-of-Pocket Maximum



Do Medicare Supplement Plans have an out-of-pocket maximum?
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Does Medicare supplement Plan G have a maximum out-of-pocket maximum limit?
Does Medicare Supplement Plan G-HD High deductible have an out-of-pocket maximum limit
Does Medicare Supplement Plan N have an out-of-pocket maximum limit?

Medicare supplement maximum out-of-pocket. Yes, most Medicare supplement plans have a defined annual maximum out-of-pocket. But I hear from people and have seen written that Medicare supplement do not have a maximum out-of-pocket.
Where does the confusion come from? Believe it or not, Medicare. From very poorly communicated benefits directly from Medicare publications.

We look at all the Medicare supplement plans and their maximum out-of-pocket limits, including Medicare supplement Plan K and Plan L.

If you have Medicare supplement Plan A or Plan B, you will pay whatever Medicare doesn’t pay. Which means if you spend 100-days in a skilled nursing facility you will pay up the maximum of $14,840. If you have any other supplements except supplement plans K and L, you have 100% coverage. 100-days of skilled nursing care cost you nothing out-of-pocket. Zero.
With Medicare supplement Plan K you will pay 50% of that $14,480 up to the policy maximum of $6,220 for 2021. It will change every year. If you have a Plan L you will pay up to the maximum out-of-pocket of $3,110.
So, the reason that Medicare supplement Plans K & L have an out-of-pocket maximum is because it’s only partial coverage for major services. The consumer has a large financial exposure to medical bills because you do not have 100% coverage for these major services.

Think of the out-of-pocket maximum as only referencing the benefits that are covered at either 50% or 75% by these two plans.

Does Medicare supplement Plan N have a maximum out-of-pocket? Using the rules of the benefit table that number would be zero plus the office visit or emergency room copays. For all practical purposes it will be a number less than twice the Medicare Part B deductible and certainly much lower than Medicare supplement Plans K and L.

Considering what you now know, what is the maximum out-of-pocket for a Medicare supplement Plan G?
Well, excluding Foreign Travel – to be fair, Medicare does not cover any foreign travel emergency healthcare. That is just something extra the supplement has thrown in.
Medicare supplement Plan G covers 100% of every Medicare service it covers. The only inpatient or outpatient Medicare service it does not cover is the annual Medicare Part B deductible. That is $203 for 2021 and will probably be around $215 for 2022. That’s it.
If you were to list a maximum out-of-pocket the way this table is designed, it would be zero. But considering real life, your maximum out-of-pocket will be the Medicare Part B deductible. Which is a heck of a lot less than the financial exposure you have with Medicare supplement Plans K and L.

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32 comments

  1. You also mentioned that the premium will go up higher every year. If your income go up higher of example you receive RMD every year will that affect your premium of your medicare supplement sir? Need an answer please

  2. Now, I get that there is premium for Medicare Supplement for 75 years of age like me but can you give an estimate of the monthly premium if i will get plan G as medicare supplement please sir

  3. Very informative as always. For my analysis to compare advantage and medigap plans I include Part D premiums and the annual premiums for the particular plan. Bottom line: In a 10 yr period the maximum exposure is about 50% compared toAdvantage plans

  4. if I sign up for plan G in state X and then move to state Y which also has a plan G, do I have to switch insurance or can I keep the insurance from state X? Thanks!

  5. What plan would you consider to be the best plan with the least amount of worries to have?
    Also in my paperwork it showed that I had 365 days a year nursing home nursing care or extra care if I needed it so I don't know why in your video you said after a hundred days or whatever that you don't have coverage cuz my paperwork so that I do.

  6. Good video, thanks. I’m 65 soon will be 66. I have Medicare but I do not draw social security retirement, I start a knee job 11/1/21 with medical benefits. As of now I do have Medicare advantage, but would like to enroll with WellCare that would cover half ($70) of the ($148) per month. I am confused due to not drawing the SS retirement. Suggestions ?

  7. What about Plan N "office visit" co-pays? These are for diagnostic and management CPT codes. There is no limit on this other than people are probably not going to the doctor or multiple doctors every day of over week.

  8. I watch and try to comprehend your video about medicare. It is too long and cannot absorb all the details. Anyway all that what I am interested to know is the final and complete explanation of how much it cost to enroll in medicare. I already have tricare. Thank you for the video.

  9. Thak once again Mathew, you've explained this well. May I interject here? When talking about "out of pocket" expenses, please say This is an annual expense, or per year expense or however you can explain this. Some of us don't grasp that to well. I'm a client (customer) of yours Sir, you've initially guided me through choosing medicare in all aspects! Thank you!

  10. Our federal government is totally out of control. What does it cost us for this "service"? Thanks for another great video.

  11. I have learned so much reviewing the information and I have saved money twice. I keep on watching his videos to keep informed. The videos are detailed and easy to understand. Thanks and keep up the great work!!!!

  12. I agree with below, I love this agency. When I signed on last year it was great service and my questions going forward are answered quickly and cleanly…no new sales pitch, just great coverage and customer service.

  13. Another useful video. I was aware of the points you were making but that is because I've spent an inordinate amount of time trying to understand Medicare benefits. Good point to stress the notion of annual out of pocket limit only applies to benefits the plan cover, not your actual dollar liability. I realize I'm preaching to the choir here but the US health care system has too many moving parts and places too much risk on individuals.

  14. We've been with Mathew for 2 years and love the easy way he keeps us informed. Also, if you ever have a question, response is quick and thorough. Thanks Mathew!

  15. VERY CLEAR explanation! My personal opinion is anything government related, information is often muddled at best. Thanks for the help!

  16. I need advice/help. I had a stroke on 6/25/2019. I am paralysis on right side arm and leg and I have Aphasia. I can talk but it takes while with some words so e-mail and Zoom or in person. I signed Medicare early of this year and I will have Medicare as of 12/1/2021. I have watched your videos about Medicare and I feel that I would works a G-HD. And possibly D and possibly more with your advice. I only take blood pressure and minimum does of Baclofen for spasity because I get too sleepy. I was taking shots Botox to help but looks my CORBA Insurance earlier of the year. I'm hoping to get shot's again with Medicare but I will the right supplement policy, with your help, Sharon.

  17. I'm a RVer and can chose any state to domicile. What is the lowest cost state / location so I can domicile there and save money.

  18. Thank you for asking for comments. Your topic is exactly what I am trying to calculate. Sorry but no, this information was not helpful. If you can provide direction, it would be greatly appreciated. I am looking for more details than an overview answer. Depending on premium differentials, co-insurance amounts, percentage of co-insurance, etc these items are what determine a plan's max out of pocket. I thought you were going to shed light on how to determine the moop instead of just saying the part b deductible is the moop, unless of course all premiums are in the same ballpark. Is the only way to determine this, by plugging in actual CMS approved amounts from previous EOBs on each supplement plan and then calculate the up to 20% for plan N, and the 25% of 20% for plan L, then excess charges for plans D, L, M, & N? Then what for GHD?? I am trying to compare my few office visits currently with potential expenses if 2 week hospital stay and 31 day skilled nursing were necessary for a couple of times to see if any of the plans mentioned are more cost effective than my regular plan G that has increased premiums by $22/month over the past 2 years. An advantage plan seems to be much more costly for these potential scenarios. Am I on the right track? Please help. Thank you.

  19. Some states like Ohio, don’t allow excess charges in Plan N, so that consideration is mute when it come to out of pocket maximum consideration.

  20. I would like to see the maximum amounts covered on each category. My current employer provided coverage has no limits on lifetime benefits, I believe. Hence, keeping it as secondary seems to make sense. Am I not asking the right questions of my carrier?

  21. You made it easy to understand as you always do. Looking forward to our appointment with one of your staff next week.

  22. For a Skilled nursing facility care in a Medigap plan don't you have to be an inpatient in a hospital for three days vs being an out patient?

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