Medicare Out-of-Pocket Costs and Maximums in 2026

Updated June 4, 20268 min readReviewed against medicare.gov

No — Original Medicare (Part A and Part B) has no yearly out-of-pocket maximum, so there is no cap on what you could pay in a year for covered care unless you add other coverage. To get an out-of-pocket limit, you can join a Medicare Advantage plan (which by law must cap in-network spending at no more than $9,250 in 2026), add a Medigap policy (Plans K and L have their own caps of $8,000 and $4,000 in 2026, and most other lettered plans cover so much that your spending is very low), or qualify for Medicaid. Separately, Part D prescription drug coverage now has its own cap: once your out-of-pocket drug costs reach $2,100 in 2026, you pay $0 for covered drugs the rest of the year. Premiums, services Medicare does not cover, and (with Advantage) out-of-network care can still cost extra after you hit a cap.

Does Original Medicare have an out-of-pocket maximum?

No. Original Medicare — Part A (hospital) and Part B (medical) — does not include any annual out-of-pocket maximum. There is no point in the year where Medicare starts paying 100% of your share. In theory, your costs for covered care could keep adding up with no ceiling.

This surprises many people, because most job-based and Marketplace health plans are required to cap your yearly spending. Original Medicare is different. The only way to put a limit on your out-of-pocket costs is to add other coverage: a Medigap (Medicare Supplement) policy, a Medicare Advantage plan, Medicaid, or employer/retiree/union coverage.

A big reason there is no annual cap is the way Part A hospital costs work. The Part A deductible is charged per benefit period, not per year — and a benefit period can start over multiple times in a single year (more on that below). Those repeating charges, plus the open-ended 20% Part B coinsurance, mean Original Medicare alone has no built-in stopping point.

Your 2026 Original Medicare costs (deductibles, premiums, coinsurance)

Even without an annual maximum, it helps to know the specific 2026 amounts you may face. These are the federal figures from CMS for 2026.

Part B standard monthly premium: $202.90 (higher earners pay more — see IRMAA below).
Part B annual deductible: $283. After you meet it, you generally pay 20% of the Medicare-approved amount for most Part B services — with no upper limit under Original Medicare.
Part A monthly premium: $0 if you have 40+ quarters of Medicare-covered work; $311 with 30-39 quarters; $565 with fewer than 30 quarters.
Part A inpatient hospital deductible: $1,736 per benefit period (this can be charged more than once in a year).
Part A hospital coinsurance, days 61-90: $434 per day.
Part A lifetime reserve days (days 91+, 60 reserve days over your lifetime): $868 per day.
Skilled Nursing Facility coinsurance, days 21-100 per benefit period: $217 per day.
Part D national base beneficiary premium: $38.99 per month (used to calculate the late-enrollment penalty; your actual plan premium varies).

Why the Part A hospital deductible can hit more than once a year

The Part A deductible is tied to a 'benefit period,' not the calendar year. A benefit period begins the day you are admitted as an inpatient and ends after you have been out of a hospital or skilled nursing facility for 60 days in a row.

If you are admitted again after that 60-day gap, a new benefit period starts and you pay the $1,736 deductible again. There is no limit on how many benefit periods you can have in a year. Someone with several separate hospital stays could pay the deductible two, three, or more times in twelve months.

This is the clearest example of why Original Medicare has no annual cap — and why many people add supplemental coverage to protect against repeated or extended hospital costs.

How to add an out-of-pocket limit (Advantage, Medigap, Medicaid)

Because Original Medicare has no maximum, the way you get one is by choosing or adding coverage. Here are your main options and their 2026 limits.

Medicare Advantage (Part C): By law, every Advantage plan must cap your in-network out-of-pocket spending. The federal ceiling for 2026 is $9,250 in-network — a plan cannot set its in-network limit higher (it dropped from $9,350 in 2025). After you reach your plan's limit, the plan pays 100% of covered Part A and Part B services for the rest of the year. Many competitive plans voluntarily set lower limits; the 2026 enrollment-weighted average in-network limit is about $5,421 (KFF), and some plans set roughly $3,000-$5,500. Always check the exact figure in the specific plan's documents.
PPO Advantage plans: If you have a PPO and use out-of-network providers, a separate, higher combined (in-network + out-of-network) limit applies — the federal ceiling for 2026 is $13,900. Staying in network keeps you under the lower in-network cap.
Medigap (Medicare Supplement): Most lettered Medigap plans (like G or N) do not have a stated annual maximum because they pay so much of your Part A/B cost-sharing that your out-of-pocket spending stays very low and predictable. Plans K and L are the exceptions — they have explicit yearly out-of-pocket limits (see the next section).
Medicaid or a Medicare Savings Program: If you have limited income and resources and qualify, these programs can cover much or all of your Medicare cost-sharing, effectively limiting what you pay. Extra Help (the Part D Low-Income Subsidy) can sharply reduce drug costs.
Employer, retiree, or union coverage: These plans may add their own out-of-pocket protections on top of Medicare.

Medigap Plan K/L limits, high-deductible plans, and the Part D drug cap

A few specific caps are worth knowing for 2026:

Medigap Plan K out-of-pocket limit (2026): $8,000. After you reach it, Plan K pays 100% of covered Part A/B costs for the rest of the year.
Medigap Plan L out-of-pocket limit (2026): $4,000. After you reach it, Plan L pays 100% of covered costs for the rest of the year.
High-deductible Medigap Plans F, G, and J deductible (2026): $2,950. You pay this much in covered out-of-pocket expenses (not counting your premium) before the high-deductible policy starts paying.
Part D out-of-pocket cap (2026): $2,100. Once your out-of-pocket spending on covered Part D drugs reaches $2,100 in the year, you pay $0 for covered drugs the rest of the year. This drug cap is separate from any medical out-of-pocket limit — it does not count toward a Medicare Advantage medical MOOP, and the medical MOOP does not count toward it.

IRMAA surcharges and what you still pay after hitting a cap

If your income is higher, an Income-Related Monthly Adjustment Amount (IRMAA) is added to your Part B and Part D premiums. For 2026, IRMAA generally applies if your 2024 modified adjusted gross income was above $109,000 (single) or $218,000 (joint). With IRMAA, the total Part B premium ranges from $284.10 to $689.90 per month, and a Part D surcharge of $14.50 to $91.00 per month is added on top of your drug plan premium.

It is important to understand what an out-of-pocket maximum does and does not cover. Reaching your plan's cap does not make everything free.

Premiums never count toward an out-of-pocket maximum, and you keep paying them. Services Medicare does not cover at all — and, with a Medicare Advantage PPO, care you get out of network — can still cost you after you reach your in-network limit. Part D drug costs are tracked under the separate $2,100 drug cap, not your medical maximum. Always read your plan's Evidence of Coverage to see exactly what counts toward your limit, because details vary by plan.

Frequently asked questions

Is there a maximum out-of-pocket limit on Medicare?

Original Medicare (Part A and Part B) has no annual out-of-pocket maximum. You can add a limit by joining a Medicare Advantage plan (capped at no more than $9,250 in-network in 2026), buying a Medigap policy, or qualifying for Medicaid. Part D drug coverage separately caps your out-of-pocket drug costs at $2,100 in 2026.

What is the 2026 Medicare Advantage out-of-pocket maximum (MOOP)?

For 2026, the federal ceiling for a Medicare Advantage plan's in-network out-of-pocket maximum is $9,250 — a plan may not set it higher (it was $9,350 in 2025). Many plans set lower voluntary limits; the 2026 enrollment-weighted average in-network limit is about $5,421 (KFF). PPO plans also have a higher combined in-network/out-of-network limit, with a federal ceiling of $13,900 for 2026. Check the exact amount in each plan's documents.

Is there an out-of-pocket cap on Part D drug costs in 2026?

Yes. In 2026, once your out-of-pocket spending on covered Part D prescription drugs reaches $2,100, you pay $0 for covered drugs for the rest of the year. This drug cap is separate from any medical out-of-pocket maximum — the two do not count toward each other.

Do Medigap plans have an out-of-pocket maximum?

Most lettered Medigap plans do not state an annual maximum because they cover so much of your Part A/B cost-sharing that your out-of-pocket spending stays very low. The exceptions are Plan K and Plan L, which have explicit yearly limits of $8,000 and $4,000 for 2026. After you reach the limit, the plan pays 100% of covered costs for the rest of the year.

Can I pay the Part A hospital deductible more than once in a year?

Yes. The 2026 Part A deductible of $1,736 is charged per benefit period, not per calendar year. A new benefit period starts after you have been out of a hospital or skilled nursing facility for 60 days in a row, so a year with several separate hospital stays can mean paying the deductible more than once. This is a key reason Original Medicare has no annual out-of-pocket cap.

After I reach my plan's out-of-pocket maximum, what do I still pay?

Premiums never count toward the maximum and continue. Services Medicare does not cover, and (on a Medicare Advantage PPO) out-of-network care, can still cost you after you hit the in-network cap. Prescription drugs are tracked under the separate $2,100 Part D cap. Read your plan's Evidence of Coverage, since what counts toward the limit varies by plan.

Sources

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Medicare Login Guide is an independent resource and is not affiliated with or endorsed by Medicare, the Centers for Medicare & Medicaid Services, or any government agency. This article is for general information only — confirm current figures and your specific options at medicare.gov or by calling 1-800-MEDICARE.