Your maximum out-of-pocket (MOOP) limit is the cap on how much you will have to pay out-of-pocket, which varies depending on the Medicare part and plan.
Your Medicare out-of-pocket cost is the amount you pay after Medicare pays its share of your medical benefits, and it can be costly.
In fact, people enrolled in Medicare might be paying more out-of-pocket on healthcare than people enrolled in private insurance plans, at 13.6% vs 6.5%, respectively, according to an analysis of a survey by the Bureau of Labor Statistics Consumer Expenditure.
Some plans, however, have a MOOP that caps how much you’ll spend out-of-pocket, and certain resources may also help lower the financial burden.
In this article, we’ll examine MOOPs and the amount you’re likely to pay with each type of Medicare coverage.
Here’s a look at the MOOPs for each part of Medicare:
- Original Medicare: With both Part A and Part B, there’s no MOOP.
- Medicare Part C: Medicare Part C (Medicare Advantage) plans may have two different MOOP levels—one for in-network and one for out-of-network. In 2025, Medicare requires all these plans to cap their MOOP at $9,350 in-network and $14,000 out-of-network.
- Medicare Part D: In 2025, all plans will cap out-of-pocket drug spending at $2,000.
- Medicare supplement insurance: Two Medicare supplement insurance (Medigap) plans come with a MOOP in 2025: Plan K with a cap of $7,220 and Plan L with a cap of $3,610.
While Medicare is designed to cover the bulk of your medical expenses, the system was designed with high cost sharing and no out-of-pocket limits in Original Medicare. The more medical services you need, the more you’ll pay in Medicare costs.
The idea is that this will help drive responsible use of medical services. It also means that you could pay a lot out of pocket after Medicare has paid its share.
Does Medicare cover 100% of hospital bills?
Medicare Part A costs include your share of expenses for any inpatient treatments or care. Most people don’t pay a premium for Part A, but in 2025, there’s a deductible of $1,676. Once you’ve paid this amount, your coverage will kick in, and you’ll only pay a portion of your daily costs based on how long you’ve been in the hospital.
Here’s a breakdown of the daily out-of-pocket costs for 2025 after you’ve met your Part A deductible:
| Out-of-pocket cost | Length of stay |
|---|---|
| $0 | first 60 days of inpatient hospital care |
| $419 per day | days 61–90 of inpatient care |
| $838 per day | days 91+ of inpatient care until you exhaust your lifetime reserve days |
| all costs | after you’ve used all 60 lifetime reserve days |
Each time you are admitted as an inpatient to a hospital or other care facility, you begin a new benefit period. This period ends after you’ve been out of the facility for at least 60 days.
With every new benefit period, you’ll have to meet the $1,676 deductible before coverage begins. An unlimited number of benefit periods can occur within a year and within your lifetime.
Skilled nursing facility costs
The rates and benefit periods vary when receiving care in a skilled nursing facility.
- Days 1 to 20: These are fully covered without out-of-pocket costs to you.
- Days 21 to 100: These will cost you $209.50 per day in 2025.
- Days 101 and beyond: You are responsible for the total cost of care with no MOOP.
Does Medicare cover your full outpatient costs?
Medicare Part B covers outpatient medical care. Monthly premiums apply for this coverage, and costs are driven by your income level.
You’ll also pay an annual deductible in addition to the monthly premiums, and you must pay a portion of any costs after you meet the deductible.
Here is an overview of the different out-of-pocket costs with Part B for 2025:
- Monthly premium: Premiums start at $185 per month in 2025 and increase with your income level.
- Annual deductible: In 2025, your Part B deductible is $257 per year. You must pay this amount once for the entire year, and then your Part B coverage will kick in.
- Coinsurance: After you meet your deductible, you will pay 20% of the Medicare-approved amount for most of your medical costs. Some services, like preventive care, are supplied without a coinsurance cost.
What are your Medicare Advantage (Part C) out-of-pocket costs?
Medicare Part C (Medicare Advantage) plans are sold by private insurance companies and offer combined packages to cover your Medicare Part A, Part B, and even prescription drug costs.
These may be the most confusing when it comes to figuring out your out-of-pocket costs. Premiums, deductibles, coinsurance, and out-of-pocket costs vary among these plans, but there are some regulations.
In 2025, your costs (premiums, deductibles, copayments, and coinsurance) vary by plan and typically don’t count toward your MOOP. If your Medicare Advantage plan includes Part D coverage or medication costs, your Part D cost-sharing also doesn’t count toward your MOOP.
You may want a plan that costs more upfront with lower out-of-pocket costs, or you may prefer one with costs lower upfront with the chance that you may be responsible for more out-of-pocket costs later, depending on how much care you need during the year.
There are different types of Medicare Advantage plans, and you can find the plans in your area on Medicare.gov.
What are your Medicare Part D out-of-pocket costs?
Medicare Part D covers your prescription drug costs.
Part D (prescription drug coverage) plans are offered by private insurance companies, and like with Part C, their costs vary based on your chosen plan.
If you buy Medicare Part D coverage, you can choose from various plans.
Medicare Part D out-of-pocket costs for 2025 include:
- Monthly premium: This is a monthly cost for your plan that can vary based on your income level.
- Annual deductible: You’ll pay this amount before your plan begins its coverage. The yearly maximum deductible for 2025 varies by plan and pharmacy.
- Coinsurance and copayments. After you’ve met your deductible, you’ll pay these costs out of pocket for your prescriptions.
- Catastrophic coverage: Once you reach the $2,000 cap, you’ll receive “catastrophic coverage” and won’t have to pay for any covered Part D drugs for the rest of the year.
- Insulin: If you have diabetes and need insulin, your cost will be capped at $35 per month. For a 3-month supply, you won’t pay more than $105.
Learn more: Part D (drug coverage).
A number of ways that may help you cover the out-of-pocket costs of your Medicare coverage.
- Medigap: These plans can help offset any out-of-pocket costs you may be responsible for paying. Each Medigap plan is different, and out-of-pocket costs may vary by plan.
- Medicare savings accounts (MSAs): MSAs are savings accounts funded by Medicare for eligible healthcare costs.
- Medicare savings programs (MSPs): There are four plans and each has different qualification criteria.
- PACE: If you’re 55 or older, require nursing home care, and also qualify for Medicaid, PACE may be an option.
- Extra Help: This is Part D low-income subsidy, known as Extra Help, offering financial aid for prescription drugs based on your income.
Learn more: How do I pay for Medicare?
Medicare covers many of the medical expenses of those who are eligible for the program. While you pay for Medicare coverage through taxes during your working years, you will still have to pay for a portion of your hospitalizations, doctor’s visits, medical equipment, and medications.
Generally, people who use more medical services pay the most in out-of-pocket expenses. Your out-of-pocket limits will vary based on the type of plan or plans you choose and how much you are willing to pay upfront.