Traditional Medicare does not have an out-of-pocket spending cap, unlike in Medicare Advantage and most commercial plans (like employer-based coverage) available to people under age 65. This can result in very high expenses for enrollees with significant health problems.
More than 4.5 million Medicare enrollees (12 percent) will incur over $5,000 in cost-sharing expenditures next year. A $5,000 out-of-pocket spending cap for traditional Medicare would:
A $5,000 out-of-pocket spending cap for traditional Medicare would result in significant savings for enrollees with the greatest healthcare needs. An out-of-pocket spending cap would also result in reductions in supplementary insurance payments, premiums for Medigap plans, and federal Medicaid expenditures for enrollees dually covered by Medicare and Medicaid.
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