Medicare Out-of-Pocket Costs
May 20, 2026
Medicare out-of-pocket costs, listed.
Premiums are only part of the picture. Here is what most people actually pay beyond their premium, and how Medigap or Advantage caps it.
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Costs even with Medicare
- Part B premium, paid monthly (often deducted from Social Security)
- Part B deductible, paid each calendar year before Medicare picks up most costs
- Part A hospital deductible, per benefit period if you are admitted
- Coinsurance, typically 20% of approved amounts after Part B deductible (uncapped unless you have Medigap or Advantage)
- Drug costs, Part D deductible + tier copays + coverage-gap exposure for high-cost drugs
- Dental, vision, hearing, mostly out of pocket on Original Medicare. See our DVH guide.
- IRMAA, income-based surcharge on Part B and D premiums (for higher-income retirees)
How Medigap caps it
A Medicare Supplement plan (Medigap) pays most or all of the coinsurance and copays Original Medicare leaves uncovered. Plan G covers everything except the Part B deductible. See Plan G.
How Medicare Advantage caps it
Medicare Advantage plans include a federal in-network out-of-pocket maximum, capping your worst-case yearly spending on covered services. Once you hit that cap, the plan covers 100% for the rest of the year.
But: out-of-network care, prior authorization denials, and non-covered services do not count toward the cap. Always read the plan's specific rules.