Medicare Advantage Out-of-Pocket Limits: Variation and Trends - Takeaways - MDSpire

Medicare Advantage Out-of-Pocket Limits: Variation and Trends

  • By

  • Nancy Ochieng

  • Meredith Freed

  • Jeannie Fuglesten Biniek

  • Juliette Cubanski

  • Tricia Neuman

  • May 28, 2026

  • 0 min

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  • 1

    In 2026, the average out-of-pocket limit for Medicare Advantage enrollees is $5,421 for in-network services and $9,825 for combined services.

  • 2

    About 19% of Medicare Advantage enrollees face in-network limits above $7,000, while 13% are in plans with limits of $3,000 or less.

  • 3

    The average out-of-pocket limit for in-network services is higher for PPOs ($6,592) than for HMOs ($4,636) in 2026.

  • 4

    The average out-of-pocket limit decreased by nearly $600 from 2017 to 2023, then increased by about $700 from 2023 to 2026.

  • 5

    Enrollment distribution between HMOs and PPOs affects average out-of-pocket caps, with rural areas facing higher limits than urban areas.

Original Source(s)

Medicare Advantage Out-of-Pocket Limits: Variation and Trends

  • by Nancy Ochieng, Meredith Freed, Jeannie Fuglesten Biniek, Juliette Cubanski, Tricia Neuman

  • May 28, 2026

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