Does Medicare Have a Maximum Out-of-Pocket?
One of the most common questions people ask when enrolling in Medicare is: “What’s the most I could spend in a year?”
The answer depends on the type of Medicare coverage you have - and it’s more important than most people realize.
Original Medicare (Parts A and B)
Original Medicare does NOT have a maximum out-of-pocket limit.
This means there is no cap on what you could spend in a year for your share of costs.
In 2026, you are responsible for:
Part A hospital deductible: $1.736 per benefit period
Part B deductible: $283 per year
Part B coinsurance: typically 20% of services
Because there’s no limit, a serious illness or extended hospital stay could lead to very high out-of-pocket costs.
Medicare Advantage (Part C)
Medicare Advantage plans DO have a maximum out-of-pocket (MOOP)
In 2026:
The maximum allowed out-of-pocket limit is $9,350 for in-network services
Once you hit that limit, the plan pays 100% of covered services for the rest of the year.
Many plans set lower limits than the maximum, but they cannot go higher than this amount.
Why This Matters
The lack of a cap with Original Medicare is one of the biggest financial risks for beneficiaries.
That’s why many people choose to:
Add a Medicare Supplement (Medigap) plan to reduce out-of-pocket costs
Or enroll in a Medicare Advantage plan (Part C) for built-in financial protection
Final Thoughts
When it comes to Medicare, it’s not just about what’s covered - it’s about what you could owe.
Original Medicare = No spending limit
Medicare Advantage = Annual out-of-pocket protection
Understanding this difference can help you choose coverage that protects both your health and your finances.