A Medicare Advantage plan can advertise a low premium and still leave you with a large bill if you need a lot of care. The number that caps those medical bills is the maximum out-of-pocket limit, often called the MOOP. CMS sets how high that limit is allowed to go. Each plan then picks its own amount, at or below that ceiling, and prints it in the plan documents.
What CMS allows in 2027
In the calculation file posted on CMS’s Medicare Advantage rates page, the highest in-network MOOP a plan may use in 2027 is $9,850. That is up from $9,250 in 2026. The file’s mandatory in-network range for 2027 is $7,151 to $9,850.
Local and regional PPOs also have a combined limit that counts in-network and out-of-network Parts A and B costs together. The highest combined amount CMS allows for 2027 is $14,800, up from $13,900 in 2026. The mandatory combined range is $7,151 to $14,800.
Those figures are ceilings, not the amount every plan charges. CMS also publishes lower and intermediate ranges. A plan that uses a lower ceiling gets less room to set high copays for individual services. The plan you are looking at may stop well below $9,850. You only know by reading that plan’s Summary of Benefits or Evidence of Coverage.
What the cap does not include
The MOOP CMS describes is for Medicare Parts A and B services. Part D drug costs do not count toward it. A year of prescriptions can add spending on top of the medical cap. Premiums do not count toward the cap either. Neither does care the plan does not cover.
Out-of-network care on a PPO counts toward the combined limit, which can be much higher than the in-network number. An HMO generally expects you to stay in network, except for emergencies and urgently needed care.
Compare more than the premium
A lower premium is one line on the page. Before December 7, also check:
- The plan’s own in-network out-of-pocket limit, and the combined limit if it is a PPO
- Copays or coinsurance for the doctors, hospitals, and services you actually use
- Whether your doctors and hospitals are in the network
- What your prescriptions cost on that plan’s formulary
Do the drug and doctor check on Medicare Plan Finder. A news story can point at a national premium trend. It cannot tell you the limit printed in your county’s plan.
How that differs from Medigap
Medicare Advantage and Medigap solve different problems. An Advantage plan bundles medical coverage, and usually drugs, into one card with a network and a yearly out-of-pocket ceiling that the plan sets. Medigap works with Original Medicare. You pay a Medigap premium, and the policy pays a defined share of Medicare-approved charges. That cost is easier to predict, because it does not reset around a plan’s copay schedule each year.
The tradeoff is enrollment. Outside specific windows, a Medigap company can ask health questions and can decline you. A routine Annual Notice of Change does not, by itself, open a federal right to buy Medigap without those questions. Oregon and Idaho have birthday windows that are separate from Annual Enrollment. See when to compare Advantage and Medigap side by side and how the Oregon and Idaho birthday windows differ from Annual Enrollment.
Annual Enrollment ends December 7
Coverage chosen by December 7, 2026, starts January 1, 2027. We can walk through the premium and the out-of-pocket limit on the plans available where you live.
Sources
- CMS — Medicare Advantage Rates & Statistics, including the CY 2027 and CY 2026 MOOP and cost-sharing limit calculation files. The 2027 file lists the in-network mandatory limit at $9,850 (2026: $9,250) and the combined mandatory limit at $14,800 (2026: $13,900).
- The Washington Post — How to choose your Medicare Advantage plan (November 9, 2026). Used for context: a lower premium can come with other costs. This article does not repeat premium averages from that story.