Original Medicare lacks an out-of-pocket maximum, leaving beneficiaries liable for 20% of Part B costs without a cap.
Original Medicare imposes no annual out-of-pocket limit, requiring beneficiaries to pay 20% of Part B costs after a $283 deductible. For a cancer patient with $150,000 in services, this results in $30,000 in coinsurance alone.
Medicare Part B covers physician services, outpatient treatment, and infused drugs, with beneficiaries typically responsible for 20% of approved amounts. Unlike private insurance, there is no ceiling on these costs, exposing patients to potentially unlimited financial liability.
Medigap Plan G can eliminate coinsurance exposure, but missing the six-month enrollment window at age 65 may make coverage permanently unavailable. The lack of an out-of-pocket maximum remains a critical gap for retirees on Original Medicare.