Medicare Advantage Out-of-Pocket Limits: Variation and Trends
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By
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Nancy Ochieng
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Meredith Freed
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Jeannie Fuglesten Biniek
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Juliette Cubanski
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Tricia Neuman
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May 28, 2026
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Objective:
To analyze out-of-pocket limits in Medicare Advantage plans in 2026, including variation by plan type and trends over time.
Key Findings:
- The average out-of-pocket limit for in-network services in 2026 is $5,421, with a maximum limit of $9,250.
- 13% of enrollees are in plans with limits of $3,000 or less, while 19% face limits above $7,000.
- PPOs have higher average out-of-pocket limits ($6,592) compared to HMOs ($4,636).
- The average out-of-pocket limit decreased from $5,253 in 2017 to $4,685 in 2023, then increased to $5,421 by 2026.
Interpretation:
Limitations:
- The analysis does not show the share of enrollees that reach their plan’s out-of-pocket limit due to lack of spending data.
- Excludes special needs plans and employer-and union-sponsored group plans.
Conclusion:
