Is there an out-of-pocket maximum for Medicare Part B?

Asked by: Shea Hahn  |  Last update: October 8, 2025
Score: 5/5 (58 votes)

It's important to know that the Medicare out-of-pocket maximum does not apply to original Medicare (Parts A and B), which has no annual OOP limit.

Does Medicare pay 100% on part B?

Medicare Part B coinsurance

Coinsurance is a cost-sharing term that means insurance pays a percentage and you pay a percentage. With Medicare Part B, you pay 20 percent of the cost for the services you use. So if your doctor charges $100 for a visit, then you are responsible for paying $20 and Part B pays $80.

What is the maximum out-of-pocket for Medicare in 2024?

In 2024, the out-of-pocket limit for Medicare Advantage plans may not exceed $8,850 for in-network services and $13,300 for in-network and out-of-network services combined. These out-of-pocket limits apply to Part A and B services only, and do not apply to Part D spending.

Does everyone pay $170 for Medicare Part B?

Most people pay no premiums for Part A. For Medicare Part B in 2025, most beneficiaries will pay $185 per month. Certain factors may require you to pay more or less than the standard Medicare Part B premium in 2025.

Does Medicare Part B have an out-of-pocket limit?

It's important to know that the Medicare out-of-pocket maximum does not apply to original Medicare (Parts A and B), which has no annual OOP limit.

Medicare Supplement Out-of-Pocket Maximum

45 related questions found

Why is Social Security no longer paying Medicare Part B?

There could be several reasons why Social Security stopped withholding your Medicare Part B premium. One common reason is that your income has exceeded the threshold for premium assistance. Another reason could be that there was a mistake or error in your records.

Is Medicare Part B free if you're over 65?

You have to pay a monthly premium for Medicare Part B (medical insurance). If you already have other health insurance when you become eligible for Medicare, you may wonder if it's worth the monthly premium costs to sign up for Part B. The answer varies with each person and the kind of other health insurance you have.

How to avoid paying Medicare Part B?

To drop Part B (or Part A if you have to pay a premium for it), you usually need to send your request in writing and include your signature. Contact Social Security.

What are the top 5 medicare supplement plans?

💬 From our Nerds: What are the top five Medicare supplement plans? "Based on NerdWallet's Medigap rubric, I picked five best Medicare Supplement Insurance companies for 2025: AARP/UnitedHealthcare, Mutual of Omaha, State Farm, Anthem and Blue Cross Blue Shield.

Why can't Medicare patients pay out-of-pocket?

In order to serve a Medicare patient, even if they want to pay out of pocket, [the clinics] have to have some sort of agreement with the patient. This law basically protects people who are sick right now and need care.

What is the donut hole in Medicare 2025?

In 2025, the Medicare Part D coverage gap, also known as the “donut hole,” will be eliminated under the Inflation Reduction Act (IRA). Part D plan members will also enjoy the security of an annual maximum out-of-pocket cost for prescription drugs.

What to do when you hit your out-of-pocket maximum?

Once you hit this limit, your insurance typically steps in to cover the rest. Picture it like this: your deductible, copayments, and coinsurance all contribute to your out-of-pocket spending. Once you reach your out-of-pocket maximum, your insurer typically takes over and covers the rest, giving your wallet a breather.

What are the 6 things Medicare doesn't cover?

Some of the items and services Medicare doesn't cover include:
  • Eye exams (for prescription eyeglasses)
  • Long-term care.
  • Cosmetic surgery.
  • Massage therapy.
  • Routine physical exams.
  • Hearing aids and exams for fitting them.

How much money does Medicare allow you to have in the bank?

This means individuals can have any amount of assets and still qualify for a Medicare Savings Program. Assets are things that you own, such as bank accounts, cash, second homes and vehicles.

What is the 80/20 rule in Medicare?

The 80/20 Rule generally requires insurance companies to spend at least 80% of the money they take in from premiums on health care costs and quality improvement activities. The other 20% can go to administrative, overhead, and marketing costs. The 80/20 rule is sometimes known as Medical Loss Ratio, or MLR.

Is it possible to get Medicare Part B for free?

Part B is a voluntary program that requires the payment of a monthly premium for all parts of coverage. Eligibility rules for Part B depend on whether a person is eligible for premium-free Part A or whether the individual has to pay a premium for Part A coverage.

Can I drop my employer health insurance and go on Medicare Part B?

Once you stop working (or lose your health insurance, if that happens first) you have an 8-month Special Enrollment Period (SEP) when you can sign up for Medicare (or add Part B to existing Part A coverage).

Why is Medicare B so expensive?

Medicare costs, including Part B premiums, deductibles and copays, are adjusted based on the Social Security Act. And in recent years Part B costs have risen. Why? According to CMS.gov, “The increase in the Part B premiums and deductible is largely due to rising spending on physician-administered drugs.

What is the alternative to Medicare Part B?

Part C (Medicare Advantage)

Part C is known as Medicare Advantage. It's an alternative to Parts A and B that bundles several coverage types, including Parts A, B, and usually D. It may also include: Vision.

Does Medicare Part B cover dental?

For Part B-covered dental services, you pay 20% of the Medicare-approved amount after you meet the Part B deductible. If you get the covered service in an outpatient hospital or other facility setting, you'll also pay a copayment to the facility.

Who is exempt from paying Medicare Part B premiums?

Enrollees who have Medicaid, employer-sponsored health coverage, or retiree health benefits from an employer generally don't have to pay the full Medicare Part B deductible, as the other coverage picks up some or all of the cost (this varies depending on the plan).

Who qualifies for an extra $144 added to their Social Security?

To qualify for a Medicare giveback benefit, you must be enrolled in Medicare Part A and B. You must be responsible for paying the Part B Premiums; you should not rely on state government or other local assistance for your Part B premiums.

Is Medicare Part B based on your income?

If we determine you're a higher-income beneficiary, you'll pay a larger percentage of the total cost of Part B based on the income you normally report to the Internal Revenue Service (IRS). You'll pay monthly Part B premiums equal to 35%, 50%, 65%, 80%, or 85% of the total cost, depending on what you report to the IRS.