Costs and premiums
What is the Medicare Advantage out-of-pocket limit for 2027?
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Short answer
For 2027, CMS caps the yearly out-of-pocket limit a Medicare Advantage plan can set at $9,850 for in-network services and $14,800 for in-network and out-of-network services combined, up from $9,250 and $13,900 in 2026.
Each Medicare Advantage plan has its own yearly limit on what you pay for covered Medicare services, and once you reach your plan's limit you pay nothing for covered services for the rest of the year.
Original Medicare has no yearly limit on what you pay out-of-pocket unless you have supplemental coverage such as Medigap, and Medicare drug coverage (Part D) has its own out-of-pocket limit, $2,400 in 2027.
| Fact | Figure | Source |
|---|---|---|
| Highest in-network limit, 2027 | $9,850 | CMS |
| Highest combined in- and out-of-network limit, 2027 | $14,800 | CMS |
| Highest in-network limit, 2026 | $9,250 | CMS |
| Highest combined in- and out-of-network limit, 2026 | $13,900 | CMS |
| After you reach your plan's limit | You pay nothing for covered Medicare services for the rest of the year | Medicare.gov |
| Original Medicare | No yearly limit on out-of-pocket costs (unless you have supplemental coverage such as Medigap) | Medicare.gov |
| Part D drug out-of-pocket limit, 2027 | $2,400 | Medicare.gov |
What is the Medicare Advantage out-of-pocket limit?
Medicare Advantage plans have a yearly limit on what you pay for covered Medicare services, which may include different limits for in-network and out-of-network services. Once you reach your plan's limit, you pay nothing for covered services for the rest of the year. Medicare.gov lists the plan's yearly limit on out-of-pocket costs for all medical services among the things that affect what you pay in a plan.
Who sets the limit?
Each plan sets its own limit, and CMS sets the highest limit a plan may use each year: $9,850 for in-network services and $14,800 for in-network and out-of-network services combined in 2027, up from $9,250 and $13,900 in 2026. CMS publishes the limits each year with its Medicare Advantage cost-sharing calculations, which also set lower and intermediate limits that a plan may choose instead.
Does Original Medicare have an out-of-pocket limit?
No. Original Medicare has no yearly limit on what you pay out-of-pocket unless you have supplemental coverage, like Medigap, or other insurance, like Medicaid or employer, retiree or union coverage. Medigap helps pay costs Original Medicare doesn't, like the 20% Part B coinsurance. See Original Medicare vs. Medicare Advantage.
Are prescription drugs part of the limit?
No. Medicare drug coverage (Part D), including the drug coverage in a Medicare Advantage plan, has its own out-of-pocket limit: $2,100 in 2026 and $2,400 in 2027. After you reach it, you pay nothing for covered Part D drugs for the rest of the calendar year. See the Part D out-of-pocket limit.
How do I find a plan's limit?
Each year, plans set the amounts they charge for premiums, deductibles and services, and what you pay the plan can only change once a year, on January 1. Medicare.gov lists the plan's yearly limit on out-of-pocket costs among the costs to consider: compare plans at Medicare Plan Finder, and contact any plan you're interested in for details.
Good to know
More questions people ask
Is the out-of-pocket limit the same for every Medicare Advantage plan?
Does the limit include out-of-network care?
What happens after I reach the limit?
Does Original Medicare have a limit like this?
Related questions
- CMS: CY 2027 Medicare Advantage MOOP and cost-sharing limit calculations
- CMS: CY 2026 Medicare Advantage MOOP and cost-sharing limit calculations
- Medicare.gov: Compare Original Medicare and Medicare Advantage
- Medicare.gov: Understanding health plan costs
- Medicare.gov: Part D costs and coverage stages
Figures are Medicare’s, set nationally, and were checked against these pages on October 2026. For your own situation, contact Medicare.gov or 1-800-MEDICARE (TTY 1-877-486-2048).
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This page was last updated: October 2026.