The Medicare Advantage out-of-pocket maximum
The ceiling on what you pay for covered medical care in a year.
Every Medicare Advantage plan must set a maximum out-of-pocket (MOOP) limit: the most you'll pay in a year for covered Part A and Part B services. Once you reach it, the plan pays 100% of covered services for the rest of the year. Original Medicare has no such limit.
The federal ceilings
These are maximums. Many plans set lower limits, and each plan's limit is listed in its materials and the Medicare Plan Finder.
- 2026: no more than $9,250 for in-network services. PPOs also have a combined in- and out-of-network limit of no more than $13,900.
- 2027: no more than $9,850 in-network and $14,800 combined.
What counts toward it
Deductibles, copays and coinsurance for covered Part A and Part B services. Premiums don't count, and neither do Part D drug costs, which have their own yearly cap. Costs for extra benefits such as dental usually don't count either.
Why it matters
The out-of-pocket limit is what you'd pay in a bad year: a hospitalization, surgery or cancer treatment. When comparing plans, looking at the limit alongside the premium gives a truer picture than the premium alone.
Common questions
No. Part D costs have a separate cap: $2,100 in 2026.
No. That's one reason many people with Original Medicare buy a Medigap policy.
Want help with your own choices?
Every state runs a State Health Insurance Assistance Program (SHIP) with trained counselors who give free, unbiased Medicare help and do not sell plans. Find yours on our Medicare by state pages, or call Medicare at 1-800-MEDICARE (1-800-633-4227) (TTY 1-877-486-2048, 24 hours a day, 7 days a week).
Planning the rest of your coverage in retirement? We can help with life insurance later in life and final expense coverage.
Sources
- Final CY 2026 Part C Bid Review Memorandum, Centers for Medicare & Medicaid Services. Checked September 29, 2026.
- Final CY 2027 Part C Bid Review Memorandum, Centers for Medicare & Medicaid Services. Checked September 29, 2026.
- Medicare costs, Medicare.gov. Checked September 29, 2026.
General information about the federal Medicare program, not advice about your situation. Figures are for 2026 unless stated and change every year; last reviewed September 29, 2026. Quote My Policy is a private company. Not connected with or endorsed by the United States government or the federal Medicare program.
Quote My Policy does not sell Medicare plans on this site. For plan-specific help, contact Medicare at 1-800-MEDICARE (1-800-633-4227) (TTY 1-877-486-2048, 24 hours a day, 7 days a week) or your State Health Insurance Assistance Program.