Original Medicare Has No Out-of-Pocket Limit

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Original Medicare Has No Out-of-Pocket Limit Original Medicare Has No Out-of-Pocket Limit
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Just the Tip:

Original Medicare puts no yearly limit on your out-of-pocket costs. Cap them with a Medigap policy like Plan G or a Medicare Advantage plan. If you choose Medigap, buy it in your six-month open enrollment window, when insurers can’t turn you down or charge more for your health.

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Millions go without either one. KFF found that in 2023, 3.5 million people, 13% of everyone in traditional Medicare, lacked any supplemental coverage.

Without it, your share of Part B care is usually 20% of the Medicare-approved amount after the $283 deductible. By our math, a $100,000 year of outpatient cancer treatment leaves you more than $20,000 to pay. Part A adds a $1,736 hospital deductible in 2026 that you can owe more than once a year, plus daily charges for long hospital and skilled nursing stays.

Your Medigap window opens the first month you’re 65 or older with Part B, and it never repeats. Outside it, insurers in most states can ask health questions, then turn you down or charge more, unless a guaranteed issue right applies, such as your Advantage plan pulling out of your area.

Two kinds of coverage cap your costs:

  • Medigap Plan G covers your share of Medicare-approved costs except the Part B deductible, and High-Deductible Plan G caps your share at $2,950 in 2026. Both charge a monthly premium.
  • A Medicare Advantage plan usually costs less each month but can leave you owing up to $9,250 for in-network care in 2026. The average limit is $5,421, per KFF, and most enrollees are in plans that generally cover only in-network care outside emergencies.

To price Medigap, start with Mutual of Omaha. AM Best rates Mutual of Omaha Insurance Company A+ (Superior). Its online tool quotes Plan G and High-Deductible Plan G from your ZIP code, birth date, and sex, without asking for contact details. On Sept. 23, 2026, it quoted High-Deductible Plan G at $45.84 to $52.19 a month for a 65-year-old woman in Dallas (75201), Columbus (43215), and Phoenix (85004). Couples can save with its household discount where it’s available, though the amount and rules vary by state.

Plan G covers the same benefits at every insurer, so compare your Mutual of Omaha quote with Medicare.gov’s list for your ZIP code before you apply.


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