Medicare out of pocket costs, service by service

How a Medicare bill splits

Every covered service has a Medicare-approved amount: the rate CMS sets for that service in your area, not the price printed on the doctor's bill. A provider who accepts assignment agrees to charge you nothing beyond the deductible and the coinsurance on that amount. From there the bill always has the same pieces:

1. The Part B deductible, $283 in 2026, once per calendar year. Until you have met it, you pay the whole approved amount up to that figure. A lower back MRI at an imaging center in early January costs you $192, $192 of it deductible; the same scan in June, with the deductible already met, costs you $38.
2. The 20% coinsurance of the approved amount, for almost every Part B service: visits, outpatient surgery, physical therapy, medical equipment, ambulance rides. Original Medicare puts no yearly cap on it.
3. The hospital copayment, when the service is done in a hospital outpatient department. CMS publishes the copayment of each service in Addendum B of the outpatient payment system, and one service cannot cost you more than the year's Part A deductible ($1,736 in 2026). It comes on top of 20% of the doctor's fee.
4. The excess charge, only when the doctor does not accept assignment. Medicare then approves 95% of the fee, and the doctor may bill you up to 15% above that amount, the "limiting charge". For a follow-up office visit that means up to $14 more, which only some Medigap policies pay.

Medicare pays the rest directly to the doctor, hospital or supplier. The Medicare Summary Notice you get by mail shows these same lines: approved amount, what Medicare paid and the most you may be billed.

What you pay for the most searched services

The table gives, for a typical service, the national approved amount, what is left for you with Original Medicare once the deductible is met, and what is left with a Medigap Plan G policy. The amounts for your own area come out of the estimator, which uses your state's price locality.

Three things stand out. First, the place changes the bill more than the service does: the same cataract surgery leaves you $344 at an ambulatory surgery center and $564 at a hospital outpatient department. Second, a preventive screening can turn into treatment: a screening colonoscopy costs nothing ($0), but when the doctor removes a polyp you pay 15% of the approved amount in 2026, $132, with no deductible. Third, what Original Medicare does not cover you pay in full, and Medigap changes nothing: hearing aids, routine dental care, an eye exam for glasses.

Your area changes the price

The physician fee schedule multiplies relative value units by a conversion factor, $33.40 dollars in 2026, and adjusts each part with three geographic indexes: the doctor's work, the cost of running a practice and malpractice insurance. CMS publishes those indexes for 109 localities: some states are one area, others are split by county or metro area. That is why the same follow-up visit has an approved amount of $108 in Manhattan and $88 in Alabama, and your 20% goes from $22 to $18. The hospital outpatient and surgery center rates we use are national, unadjusted; the hospital near you may have a slightly different amount. Medical equipment is paid at your state's fee schedule, with a rural and a non-rural rate, and an ambulance at your locality's rate plus the miles driven.

Hospital and skilled nursing: Part A

A stay as an inpatient, admitted on a doctor's order, is paid per benefit period. In 2026 the Part A deductible is $1,736 per benefit period and covers days 1 to 60. Days 61 to 90 cost $434 each; after that you may use your 60 lifetime reserve days at $868 a day. A 5-day stay costs you $1,736; a 75-day stay, $8,246. Doctors' fees during the stay remain under Part B, with their 20%.

After an inpatient stay of at least three days in a row, a skilled nursing facility costs nothing for the first 20 days and $217 a day for days 21 to 100; from day 101 you pay everything. A 30-day month costs you $2,170. The skilled nursing page gives the day-by-day detail.

Medigap: what each letter pays

Medigap policies are private insurance that pays part of what Original Medicare leaves to you. Their benefits are standardized by law: a Plan G is the same Plan G at any insurer, only the price differs. The table sums up the medicare.gov chart for the items that enter our calculations.

With Plan G, an outpatient knee replacement done in January costs you $283: the Part B deductible and nothing more; with Original Medicare alone the same operation leaves you $2,194. Plan N pays the 20% except for a copayment of up to $20 for some office visits ($19 in our example) and up to $50 for an emergency room visit without admission. Plans K and L pay half and three quarters, with a yearly out-of-pocket limit of $8,000 and $4,000 in 2026. Plans C and F are open only to people who became eligible for Medicare before January 1, 2020. The high-deductible versions of F and G make you pay up to $2,950 in 2026 before the policy pays anything. No Medigap policy pays for what Medicare does not cover.

Medicare Advantage: your copays, not the 20%

A Medicare Advantage plan (Part C) replaces Original Medicare: it must cover at least the same services, but it sets its own copays and coinsurance, its network of doctors and its yearly out-of-pocket limit, all listed in its Summary of Benefits. Many plans add vision, hearing or dental benefits that Original Medicare lacks. Since every plan differs, the estimator lists no plan: with the "Medicare Advantage" option you type your plan's copay or coinsurance for the service and what is left before your yearly limit, and the arithmetic runs on your own figures.

Services Original Medicare does not pay for

The list of what Medicare does not cover is shorter than it looks, but it holds large expenses: hearing aids and the exams to fit them, routine dental care (cleanings, fillings, extractions, dentures), eye exams for glasses and ordinary glasses, most routine foot care, acupuncture outside chronic low back pain, and non-medical long-term care. For these services the estimator lets you type the price you were quoted: it shows that you pay all of it and, with an Advantage plan, what its extra benefit would take off.

2027: what is already known

The 2027 Part B deductible, standard premium and Part A amounts are not published yet: CMS announces them every year in a fact sheet, expected in mid-November 2026. We do not project them. The only figure already fixed by regulation is your share when a screening colonoscopy turns into polyp removal: under 42 CFR 410.152 it falls from 15% in 2026 to 10% from 2027 through 2029, and to zero in 2030. For the procedure in our example, that leaves you $88 instead of $132. As soon as CMS publishes the 2027 fact sheet, the estimator will offer the 2027 year.

Where the figures come from

The rates come from five public CMS files, all from October 2026: the physician fee schedule relative value file (RVU26D), the hospital outpatient payment system Addendum B, the ambulatory surgical center Addendum AA, the durable medical equipment fee schedule DME26-D and the 2026 ambulance fee schedule. The deductible, premium and Part A amounts come from the CMS 2026 fact sheet; the coverage rules from the medicare.gov page of each service. We selected 41 services and wrote their names ourselves; the AMA's procedure codes are not shown. The method page gives every formula and its limits. This site gives prices, not medical advice, and is not affiliated with CMS or Medicare.gov.