What are the federal out-of-pocket limits for 2027?
CMS sets three tiers each year. A plan can choose any limit up to the top of the highest tier, which is $9,850 for in-network care in 2027. A plan that picks a limit in a lower tier gets what CMS calls "increased flexibility in cost-sharing requirements," which means it may charge more for individual services.
| Tier | In-network limit, all plan types | In-network plus out-of-network, PPOs |
|---|---|---|
| Lower | $0 to $4,450 | $0 to $6,700 |
| Intermediate | $4,451 to $7,150 | $4,451 to $10,750 |
| Mandatory (highest) | $7,151 to $9,850 | $7,151 to $14,800 |
The trade shows up in individual services. CMS's service limits for 2027 allow a plan in the lower tier to charge up to $20 a day for the first 20 days in a skilled nursing facility, a plan in the intermediate tier up to $10 a day, and a plan at the mandatory tier $0 a day.
How has the Medicare Advantage out-of-pocket limit changed since 2020?
The highest in-network limit CMS allows rose from $6,700 in 2020 to $9,850 in 2027, with one dip in 2026, when it fell from $9,350 to $9,250. The combined limit for PPOs went from $10,000 to $14,800 over the same years.
- 2020$6,700
- 2021$7,550
- 2022$7,550
- 2023$8,300
- 2024$8,850
- 2025$9,350
- 2026$9,250
- 2027$9,850
Source: KFF analysis of CMS data (2020 to 2026) and CMS final 2027 Part C bid review memorandum, April 22, 2026 (2027)
What do Medicare Advantage plans in each state actually set?
CMS's September 2026 landscape file lists 1,930 plans open to everyone with Medicare in our 21 states with plans. The middle plan sets an in-network limit of $6,350. Of the 1,930, 193 (10%) set the full $9,850, 401 (21%) are in the highest tier and 517 (27%) are at or below $4,450.
Three states hold most of the plans at the top: Georgia, South Carolina and North Carolina have 115 of the 193. Nevada ($3,950), Florida ($4,200) and Arizona ($5,450) have the lowest middle limits, and no plan in Nevada sets a limit above $7,150.
| State | Plans open to everyone | Lowest limit | Middle limit | Highest limit | Plans at $9,850 |
|---|---|---|---|---|---|
| Alaska | None | None | None | None | None |
| Arizona | 90 | $1,899 | $5,450 | $9,800 | 0 |
| Florida | 308 | $500 | $4,200 | $9,850 | 4 |
| Georgia | 99 | $3,400 | $9,850 | $9,850 | 53 |
| Idaho | 33 | $3,000 | $6,700 | $9,150 | 0 |
| Indiana | 98 | $3,900 | $6,750 | $9,850 | 15 |
| Iowa | 41 | $4,000 | $6,500 | $9,850 | 2 |
| Kansas | 60 | $2,800 | $5,500 | $9,850 | 3 |
| Louisiana | 70 | $2,875 | $6,300 | $9,850 | 3 |
| Michigan | 131 | $4,000 | $6,000 | $9,850 | 12 |
| Minnesota | 40 | $3,900 | $6,900 | $9,850 | 5 |
| Missouri | 113 | $2,000 | $5,500 | $9,850 | 3 |
| Montana | 19 | $5,000 | $6,750 | $9,150 | 0 |
| Nebraska | 30 | $4,400 | $7,000 | $9,850 | 1 |
| Nevada | 58 | $900 | $3,950 | $7,150 | 0 |
| North Carolina | 120 | $3,400 | $6,950 | $9,850 | 33 |
| Ohio | 134 | $3,000 | $5,900 | $9,850 | 3 |
| Oklahoma | 52 | $3,400 | $6,050 | $9,850 | 3 |
| South Carolina | 68 | $5,900 | $9,250 | $9,850 | 29 |
| Tennessee | 105 | $1,900 | $6,200 | $9,850 | 7 |
| Texas | 228 | $1,500 | $6,500 | $9,850 | 16 |
| Utah | 33 | $4,700 | $6,700 | $9,850 | 1 |
- Georgia$9,850
- South Carolina$9,250
- Nebraska$7,000
- North Carolina$6,950
- Minnesota$6,900
- Indiana$6,750
- Montana$6,750
- Idaho$6,700
- Utah$6,700
- Iowa$6,500
- Texas$6,500
- Louisiana$6,300
- Tennessee$6,200
- Oklahoma$6,050
- Michigan$6,000
- Ohio$5,900
- Kansas$5,500
- Missouri$5,500
- Arizona$5,450
- Florida$4,200
- Nevada$3,950
Source: Our count of CMS's CY 2027 landscape file, updated September 22, 2026
Every plan counts once here, so a small plan weighs as much as one with 100,000 members and these figures are not what the average enrollee faces. KFF's enrollment weighted national average for 2026 was $5,421 in-network, and 9% of enrollees were in plans at the maximum. If a plan has different limits in different counties, we used its middle value.
What does the out-of-pocket maximum include and leave out?
It covers your share of the cost of in-network Medicare Part A and Part B services in a calendar year, such as hospital stays, doctor visits and outpatient care. After you reach it, the plan pays the full cost of covered services for the rest of the year. These costs do not count toward it:
- Your monthly premiums, including the Part B premium.
- Prescription drugs under Part D. Drug coverage has its own limit, which CMS's landscape file lists as a $2,400 out-of-pocket threshold for 2027.
- Services the plan does not cover.
- Out-of-network care. HMOs generally do not cover it, and PPOs have a separate, larger combined limit that includes it.
Original Medicare has no yearly limit on what you pay. People who want a ceiling with Original Medicare usually add a Medigap policy.
How do I compare out-of-pocket limits before I enroll?
In the Medicare Plan Finder, open a plan's details and look for the yearly limit on what you pay for health services in the network. Members of a plan can find it in the Annual Notice of Change. Compare it with the deductible, the hospital copay per day and the copays for the specialists you see, because a lower limit can come with higher costs for individual services, as the tier rules above show.
The limit matters most in a bad year, such as surgery or a long hospital stay. If you rarely use care, the premium and your drug costs may matter more. A licensed agent can put plans for your county side by side.
See our Medicare plans
Turning 65 or reviewing your plan? We'll walk through Advantage, Supplement, and Part D side by side.Health plan cost calculator
See what you would pay out of pocket for a medical bill under a plan's deductible and coinsurance.We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
Talk to a licensed agent
We compare plans, explain the tradeoffs and help you enroll. It costs you nothing.