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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