Medicare Advantage Out-of-Pocket Limits Have Climbed Nearly 700 Dollars Since 2023

The average in-network out-of-pocket spending limit in Medicare Advantage plans reached 5,421 dollars in 2026, up nearly 700 dollars from 4,685 dollars in 2023, according to a KFF analysis published in May 2026. The increase reverses a trend in which limits had generally declined from about 5,253 dollars in 2017 to that 2023 low.

CMS caps the in-network out-of-pocket limit for Medicare Advantage plans at 9,250 dollars in 2026. About 9 percent of enrollees, roughly 1.8 million people, are in plans set at that ceiling. About one in five enrollees overall are in plans with limits above 7,000 dollars. At the lower end, about 13 percent of enrollees, or roughly 2.8 million people, are in plans with limits of 3,000 dollars or less.

Average limits vary by plan structure. Health maintenance organizations have an average in-network limit of 4,636 dollars, while preferred provider organizations average 6,592 dollars. The higher PPO figure reflects the broader network access PPO members receive.

The out-of-pocket limit is the maximum an enrollee can be required to pay for covered in-network services in a plan year before the plan assumes all remaining costs. A rising average limit means a beneficiary who needs extensive care could face a larger personal bill before reaching that full protection.