What Is the Medicare Out-of-Pocket Maximum in 2026?

The out-of-pocket maximum (MOOP) is the most you will pay for covered services in a year before your Medicare Advantage plan pays 100%. Understanding this limit is essential for budgeting your healthcare costs in 2026.

Medicare Advantage MOOP Limits

In 2026, Medicare sets the maximum allowed MOOP for Medicare Advantage plans at $9,350 for in-network services. Most plans set their actual MOOP lower — typically between $4,000 and $7,500. Once you reach your plan's MOOP, the plan pays 100% of covered services for the rest of the year. Importantly, the MOOP only counts in-network costs for HMO plans. PPO plans have separate in-network and combined (in-network + out-of-network) limits.

Part D Out-of-Pocket Cap

The Inflation Reduction Act introduced a $2,000 annual cap on out-of-pocket Part D prescription drug spending starting in 2026. This is a landmark change. Previously, high-cost prescriptions could expose beneficiaries to thousands in out-of-pocket drug costs. Now, once your Part D out-of-pocket spending reaches $2,000, covered prescriptions are free for the rest of the year. The Medicare Prescription Payment Plan also lets you spread drug costs into monthly installments.

Original Medicare Has No MOOP

A critical distinction: Original Medicare (Parts A and B) has no out-of-pocket maximum. Without Medigap, your costs are unlimited. A single hospital stay can generate thousands in coinsurance. This is why supplemental coverage — either Medigap or Medicare Advantage — is so important.

What Counts Toward the MOOP?

Copays, coinsurance, deductibles, and other cost-sharing for covered services count toward your MOOP. Monthly premiums do not count. Non-covered services do not count.

Related: Best Advantage plans | Plan G vs Plan N | Part D plans

Source: Medicare.gov.

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