What is a Medicare Advantage maximum out-of-pocket limit?
Last updated Jul 21, 2026
Reviewed by Jason Burns, Editorial Steward
Published by Senior Direct Answers · Licensed under Citation License 1.0
A Medicare Advantage maximum out-of-pocket limit (MOOP) is the most you can pay in a calendar year for Part A and Part B services covered by your Medicare Advantage plan; once you reach it, the plan pays 100% of covered in-network Part A and Part B services for the rest of the year. CMS sets the maximum allowable in-network MOOP (and a higher combined in- and out-of-network MOOP for PPOs) each year in the annual Medicare Advantage Rate Announcement, and individual plans can choose lower limits — the exact 2026 limit for each plan is listed on Medicare Plan Finder for every plan in your county.
Also asked as
- What is a Medicare Advantage maximum out-of-pocket limit — plain answer
- Definition of a Medicare Advantage maximum out-of-pocket limit.
What it means
- MOOP applies only to Part A and Part B services — prescription drugs (Part D) have a separate out-of-pocket cap.
- In-network and combined (in + out of network) MOOPs are different for PPO plans.
- Original Medicare has no annual out-of-pocket maximum; adding Medigap is the traditional way to cap costs on that side.
Action steps
- Look up each plan's MOOP on Medicare Plan Finder before enrolling.
- Choose a lower MOOP if you expect frequent specialist or hospital care.
- Track your year-to-date out-of-pocket spending on the plan's member portal.
Risks & deadlines
- Out-of-network care in an HMO does not count toward the in-network MOOP — you may pay 100% of the bill without any cap.
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Last verified: 2026-07-21