Costs & IRMAA
Medicare Advantage Out-of-Pocket Limits Have Climbed Nearly 700 Dollars Since 2023
A KFF analysis finds the average in-network spending cap in Medicare Advantage reached 5,421 dollars in 2026, reversing a multi-year downward trend, with about 9 percent of enrollees in plans at the legal maximum of 9,250 dollars.
By the Goodsurance editorial teamJuly 6, 2026
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.
The average Medicare Advantage out-of-pocket limit hit 5,421 dollars in 2026, nearly 700 dollars higher than in 2023, with some plans at the 9,250-dollar ceiling.
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.
In plain words
Medicare Advantage plans have a limit on how much you pay each year for your health care. After you hit that limit, the plan pays the rest. In 2026, the average limit is 5,421 dollars. That is about 700 dollars more than it was in 2023. The highest limit any plan is allowed to set is 9,250 dollars. About 1 in 10 Medicare Advantage members is in a plan with that highest limit. HMO plans average around 4,636 dollars and PPO plans average about 6,592 dollars. A higher limit means you could end up paying more out of your own pocket if you need a lot of health care during the year.
Understand the basics first
Source: KFF
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