Out-of-Pocket Maximum (Medicare Advantage MOOP)
Annual cap on what you pay for Medicare-covered services in a Medicare Advantage plan ($9,350 in-network for 2026).
Full explanation
Medicare Advantage plans have a federally regulated annual Maximum Out-of-Pocket (MOOP) cap on what you pay for Medicare Part A and B covered services. The 2026 maximum in-network MOOP is $9,350 (combined in-and-out-of-network up to $14,000 for PPOs). Original Medicare alone has NO out-of-pocket maximum — you pay 20% coinsurance forever without a cap, which is why Original Medicare alone is rarely chosen. Plan-specific MOOPs are often lower than the federal max. Once you hit MOOP, the plan covers 100% of approved Medicare services for the rest of the year. Drug costs, dental, and vision are typically not covered by MOOP.
📎 Primary source: official source
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