Medicare Out-of-Pocket Maximum (MOOP): 2026 Cost Caps

Annual Medicare Out-of-Pocket Maximum (MOOP) Limits

Current annual limits
Coverage Type	2026 Annual Out-of-Pocket Cap	Notes
Original Medicare (Parts A & B)	No maximum	Unlimited without Medigap or Medicare Advantage
Medicare Advantage, in-network	$9,250	CMS-mandated ceiling for 2026
Medicare Advantage, combined in + out-of-network	$13,900	Applies mainly to PPO plans
Medicare Part D (drug plans)	$2,100	Catastrophic cap under the Inflation Reduction Act

Source: CMS 2026 Medicare Parts A & B Premiums and Deductibles (cms.gov).

Source: https://www.cms.gov/newsroom/fact-sheets/2026-medicare-parts-b-premiums-deductibles

Example: How It Works in Practice

For someone enrolled in a Medicare Advantage plan with drug coverage (MA-PD), the practical 2026 ceiling combines the plan's medical MOOP with the separate Part D cap. See [Medicare Eligibility](/medicare-eligibility) for enrollment rules.

Worked example
Cost Category	2026 Maximum
In-network medical costs (MA MOOP)	$9,250
Part D prescription drugs	$2,100
Combined annual ceiling	$11,350

Actual totals vary by plan; some MA-PD plans set MOOP below the CMS ceiling. Source: [CMS 2026 Medicare Advantage and Part D Rate Announcement](https://www.cms.gov/newsroom/fact-sheets/2026-medicare-advantage-part-d-rate-announcement).

Original Medicare vs. Medicare Advantage: Who Caps Your Costs?

Original Medicare enrollees without supplemental coverage face unlimited Part A and Part B cost-sharing, since Medicare sets no annual ceiling in 2026. A Medigap policy or Medicare Advantage caps that exposure. Beneficiaries near the Medicaid income limits may qualify for a Medicare Savings Program, which pays Part A and Part B cost-sharing directly.

Frequently Asked Questions

Does Original Medicare have a yearly out-of-pocket maximum in 2026?

No. Original Medicare (Parts A and B) sets no annual limit on out-of-pocket costs in 2026, so a beneficiary without Medigap or Medicare Advantage can owe cost-sharing on every covered service all year. Medicare Advantage plans, by law, must cap in-network costs at $9,250 in 2026.

How much can Medicare Part D drug costs total in 2026?

Part D out-of-pocket drug spending is capped at $2,100 in 2026 under the Inflation Reduction Act's catastrophic-coverage redesign. Once a beneficiary reaches that cap, the Part D plan covers 100% of covered drug costs for the rest of the year.

Can low-income Medicare beneficiaries avoid these costs entirely?

Yes. Beneficiaries under the [Federal Poverty Level](/federal-poverty-level)-based thresholds for a Medicare Savings Program can have Part A and Part B premiums, deductibles, and coinsurance paid by Medicaid, effectively eliminating out-of-pocket Medicare costs in 2026.

What Is the Most Medicare Can Cost in 2026?