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Rocco DeLuca — Vernal Medicare

Important Medicare Information

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY: 711), 24 hours a day, 7 days a week, to get information on all of your options.

Vernal Medicare is a licensed and certified representative of Medicare Advantage organizations and stand-alone prescription drug plans. Each of the organizations we represent has a Medicare contract. Enrollment in any plan depends on contract renewal.

Not connected with or endorsed by the U.S. government or the federal Medicare program.

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By Rocco DeLuca, Licensed Insurance Agent • Published 2026-04-04 • Last updated 2026-04-04

What Is the Medicare Out-of-Pocket Maximum in 2026?

The out-of-pocket maximum (MOOP) is the most you will pay for covered services in a year before your Medicare Advantage plan pays 100%. Understanding this limit is essential for budgeting your healthcare costs in 2026.

Medicare Advantage MOOP Limits

In 2026, Medicare sets the maximum allowed MOOP for Medicare Advantage plans at $9,350 for in-network services. Most plans set their actual MOOP lower — typically between $4,000 and $7,500. Once you reach your plan's MOOP, the plan pays 100% of covered services for the rest of the year. Importantly, the MOOP only counts in-network costs for HMO plans. PPO plans have separate in-network and combined (in-network + out-of-network) limits.

Part D Out-of-Pocket Cap

The Inflation Reduction Act introduced a $2,000 annual cap on out-of-pocket Part D prescription drug spending starting in 2026. This is a landmark change. Previously, high-cost prescriptions could expose beneficiaries to thousands in out-of-pocket drug costs. Now, once your Part D out-of-pocket spending reaches $2,000, covered prescriptions are free for the rest of the year. The Medicare Prescription Payment Plan also lets you spread drug costs into monthly installments.

Original Medicare Has No MOOP

A critical distinction: Original Medicare (Parts A and B) has no out-of-pocket maximum. Without Medigap, your costs are unlimited. A single hospital stay can generate thousands in coinsurance. This is why supplemental coverage — either Medigap or Medicare Advantage — is so important.

What Counts Toward the MOOP?

Copays, coinsurance, deductibles, and other cost-sharing for covered services count toward your MOOP. Monthly premiums do not count. Non-covered services do not count.

Related: Best Advantage plans | Plan G vs Plan N | Part D plans

Source: Medicare.gov.

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Call Rocco: 435-219-5120 (TTY: 711) • [email protected]