Why do people still get large medical bills even with Medicare?

Question

Gary Church · Accepted Answer

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Voss Speros · Answer

Voss Speros here, Greek god of Medicare. If Medicare's all Greek to you, you're in luck. I'm Greek. So the question is, why do people still get large medical bills if they're on Medicare? Well, it depends on the plan you're on. If you're on straight Medicare, which is an 80/20 plan, that 20% can lead to a large medical bill. Yes, if you want a supplemental plan, like a Plan G, then you really only have the deductible of $280 for Part B. So it's not a lot. And you have some co-payments mixed in there.

With the Advantage plans, you don't pay anything for the plan, but you have co-payments at the time of service. For a supplemental plan, you pay for the plan itself. They will show co-payments at the time of service. If you have a hospital thing happen and an ambulance picks you up, that's about $250 for the ambulance, depending on the plan. The hospital stays can range anywhere from $100 to $400 per day for the first 5 to 7 days, depending on the plan.

So if your plan is $250 a day for five days, that's a big bill, and you're going to get billed for that later. So yes, some people still have bigger bills with Medicare, depending on the plan you're on. If you're not paying anything monthly for it on the Advantage plan, you're saving a bunch of money. But then you're going to get hit with co-payments. With a supplemental plan, you pay monthly for it, and you don't get any co-payments.

So it just depends on what you're looking at. That's why, if you have any questions, give us a call. We're more than happy to send out an agent.

Ann Sanfelippo · Answer

People still get large medical bills with Medicare because it does not cover 100% of costs. Original Medicare typically leaves you responsible for deductibles, coinsurance (like the 20% under Part B), and no out-of-pocket cap, which can add up quickly. There are also coverage gaps, such as limited dental, vision, long-term care, and some services not being fully covered. Costs can increase further if providers don’t accept Medicare assignment or if services require prior authorization under Medicare Advantage. Without additional coverage like Medigap or a well-structured Advantage plan, out-of-pocket expenses can be significant.

Answered by Ann Sanfelippo on March 25, 2026

Broker Licensed in FL, AL, AZ & 14 other states

Answered by Ann Sanfelippo Medicare Insurance Agent

Edward Givens · Answer

Because Medicare was never designed to eliminate financial exposure—it was designed to share it.
And when something serious happens, “sharing the cost” can feel a lot like carrying it.

Most people think coverage equals protection.

It doesn’t.

Protection is what happens after the bill shows up—and most people have never been shown that part.

Mark Szymanski · Answer

People with Medicare often face large medical bills because it does not cover all expenses. Cost-sharing (deductibles, coinsurance, and 20% Part B copayments), high of out-of-pocket maximums in Original Medicare, uncovered services (dental, vision, hearing), and expensive prescription drugs.

Answered by Mark Szymanski on March 24, 2026

Agent Licensed in PA & NJ

Answered by Mark Szymanski Medicare Insurance Agent

Peter Young · Answer

Medicare is like an 80/20 plan. So if you had medical bills for about $100,000, Medicare would pay about $80,000 and you would be responsible for about $20,000. That's why it's important to look at either Medicare supplement plans to insure yourself against any large bills. The supplement plans pay the other 20%. The other option is Medicare Advantage plans which have what is called a MOOP or maximum out of pocket to guard against huge liabilities for the consumer.

Answered by Peter Young on April 20, 2026

Broker Licensed in MA, CT, FL & TX

Answered by Peter Young Medicare Insurance Agent

Donald Farrell · Answer

Even with Original Medicare (Part A, Part B, and Part D), people can still face large out-of-pocket costs because Medicare does not cover everything. Costs can include deductibles, copays, and coinsurance, and some services may not be covered at all. One way people reduce these costs is by adding a Medigap supplement to Original Medicare, or by enrolling in a Medicare Advantage plan, which is Part C and often includes an annual limit on out-of-pocket spending. When choosing the correct plan, it is important to sit down with a local agent to ensure you are put on a plan for your specific needs. It will ensure your doctors are in network, prescription drugs are covered, and minimize those large medical bills as much as possible.

Answered by Donald Farrell on May 8, 2026

Broker Licensed in WV, MD, PA & VA

Answered by Donald Farrell Medicare Insurance Agent

Andrew Zurbuch, MBA · Answer

Good question. If a Medicare Beneficiary has only Original Medicare then they could have 20% coinsurance to pay for Medicare Part B approved claims.  In 2026 there is no limit to the 20% coinsurance to pay for  approved claims. This could be a large amount. Please look into a Medicare Advantage plan. A Medicare Advantage plan will give you a yearly Maximum Out Of Pocket on the policy, giving you less liability on claims. 

Plans are insured or covered by a Medicare Advantage (HMO, PPO and PFFS) organization with a Medicare contract and/or a Medicare-approved Part D sponsor. Enrollment in the plan depends on the plan’s contract renewal with Medicare. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare to get information on all of your options.

Steven A James, MBA · Answer

We'd first have to clarify what is meant by "large medical bills".  If one has Medicare only, then yes, one can be exposed to very sizable out-of-pocket costs as Medicare Part B only pays 80%, leaving the beneficiary with a 20% cost exposure.  And with no caps, there's no limit to the exposure.

Part A alone has a $1,736 deductible per 60-day benefit period.  After 60 days, daily copays can rise substantially.

If one has a Medicare Supplement, Medicare pays its cost share, and the Med Supp pays most, if not all, the remaining cost share.  Plan G pays all these excess costs except for the Part B deductible, which is $283.  Other Med Supp plans will pay less of these cost shares.  However, and unfortunately, Med Supp plans continue to increase in cost, becoming more prohibitive to purchase by many.  Here in Washington, Plan G is expected to be nearly $310/mo.  In addition, Medicare only pays for medical expenses and nothing else.  So, one would have to purchase a separate stand-alone Prescription Drug Plan, which could add an additional $40-$110/mo.

Medicare Advantage Plans (Medicare Part C) integrate with your Medicare.  These plans do have copays, which generally limit your out-of-pocket costs as compared to Medicare alone.  These plans also have annual max out-of-pocket caps, so one would be limited in a catastrophic situation.

Steven A James, MBA
Contact me.

Cody Brown · Answer

Why do some people get huge medical bills even if they're on Medicare? The average seven-year-old that's only on original Medicare Part A and B would pay about $8,000 a year in medical claims. Under Part A, you'll have a hospital deductible of $1,736 in 2026. Part B deductible is $283, and then you have to pay 20% out of pocket. That's not different than most insurance plans, but with Medicare, there's no ceiling to that 20%. So your limit to the exposure of medical bills at $8,000 could be $500,000 if something really bad happened. Most people will buy a Medicare supplement plan or a Medicare Advantage plan to go along with their Medicare. So it gives them that maximum out-of-pocket. So don't leave yourself exposed like that. Educate yourself on your options before you turn 65. My name is Cody Brown with Senior Benefit Services, and I make Medicare easy.

Karen Ansell · Answer

Medicare still has large deductibles for inpatient stays and you owe 20% on all doctors that serviced you while you were in the hospital. Or they may be experiencing kemo or radiation which again is a 20% coinsurance which can be an ongoing treatment. Also Medicare does not have a cap or out of pocket maximum.

Answered by Karen Ansell on March 24, 2026

Agent Licensed in FL, GA, KY & OH

Answered by Karen Ansell Medicare Insurance Agent

Joseph Peck · Answer

If they are on a supplement, bills should be low or non-existent. On advantage plans you deal with copays for pretty much everything until you hit the max out of pocket, which, in most cases, is 4800 and higher.

Answered by Joseph Peck on May 19, 2026

Agent Licensed in MI, AL, CO, KS & TN

Answered by Joseph Peck Medicare Insurance Agent

Michael Murray · Answer

There are additional charges depending on what type of Medicare coverage that you select, their are deductibles and co-pays with many programs and then their are those that don't have them but may have a monthly premium for that coverage.

Answered by Michael Murray on March 25, 2026

Agent Licensed in NC, SC & TN

Answered by Michael Murray Medicare Insurance Agent

Taylor Wade · Answer

Getting a bill after a service could be due to a couple different reasons. The service may not be covered under the plan, doctor or facility was not in network, or you are in a plan that you share the cost of services with the insurance company.

Answered by Taylor Wade on April 6, 2026

Broker Licensed in NC, FL & SC

Answered by Taylor Wade Medicare Insurance Agent

Arlene Arkin · Answer

Medicare is complicated. If someone has Medicare only they are responsible for both Part A and B deductible each year and about 80% of Medicare Part B charges which could become quite costly since there is no Maximum out of Pocket amount as a stop point of charges.
In order to offset this many people choose a Medicare supplement offered by private companies to make up some or all of the remaining 20%. There is a premium associated with these plans. Any doctor who takes Medicare will  usually accept a medicare supplement plan as a secondary insurance plan
Other people might go into a Medicare Advantage plan which offers Part A, Part B and usually Part D(which covers medications).
There are co-pays normally with any type of service these plans offer but there is a Maximum  Out of Pocket amount. These plans take the place of Medicare and have networks of specific doctors and hospitals. They also offer HMO's and PPO's .
Again if a person only has Medicare the bills can become quite costly.

Why do people still get large medical bills even with Medicare?

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Why do people still get large medical bills even with Medicare?

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