If you are searching for 2027 Medicare Advantage out-of-pocket maximum projections, here is the short version: you no longer need a projection. CMS finalized the CY 2027 numbers on April 22, 2026. The mandatory maximum out-of-pocket limit for 2027 is $9,850 for in-network services and $14,800 combined for in-network and out-of-network care on PPO plans. That is a $600 increase over the 2026 in-network cap of $9,250 and a $900 increase over the 2026 combined cap of $13,900, roughly 6.5 percent in both cases.
That is the legal ceiling, not what most people will actually pay. Most Medicare Advantage plans set their limits well below it. Both numbers matter, and this guide covers each.
2027 Medicare Advantage MOOP Limits at a Glance
| Limit | 2026 | 2027 | Change |
|---|
| Mandatory MOOP, in-network | $9,250 | $9,850 | +$600 (+6.5%) |
| Mandatory MOOP, combined (PPO) | $13,900 | $14,800 | +$900 (+6.5%) |
| Lower MOOP, in-network | $4,200 | $4,450 | +$250 (+6.0%) |
| Lower MOOP, combined (PPO) | $6,300 | $6,700 | +$400 (+6.3%) |
| Intermediate MOOP ceiling, in-network | $6,750 | $7,150 | +$400 (+5.9%) |
| Intermediate MOOP ceiling, combined (PPO) | $10,100 | $10,750 | +$650 (+6.4%) |
Source: CMS Final Contract Year 2027 Standards for Part C Benefits, Bid Review and Evaluation (April 22, 2026), Table 3, and the equivalent CY 2026 memorandum.
The Full CY 2027 MOOP Table by Plan Type
Medicare Advantage plans do not all pick a single number. CMS defines three MOOP "types," and a plan chooses which band it wants to sit in. Here is the finalized 2027 structure.
| Plan Type | Lower MOOP | Intermediate MOOP | Mandatory MOOP |
|---|
| HMO and HMO-POS | $0 to $4,450 in-network | $4,451 to $7,150 in-network | $7,151 to $9,850 in-network |
| PPO (Local and Regional) | $0 to $4,450 in-network; $0 to $6,700 combined | $4,451 to $7,150 in-network; $4,451 to $10,750 combined | $7,151 to $9,850 in-network; $7,151 to $14,800 combined |
| PFFS (full, partial, non-network) | $0 to $4,450 | $4,451 to $7,150 | $7,151 to $9,850 |
The practical takeaway: no Medicare Advantage plan in 2027 may require you to spend more than $9,850 out of pocket on covered in-network Part A and Part B services. If you are on a PPO and you use out-of-network providers, your total exposure across both networks can reach $14,800.
Why 2026 Went Down and 2027 Went Back Up
The 2026 cap actually dropped $100 from 2025's $9,350. That confused a lot of people, and it made the 2027 direction genuinely uncertain until CMS published the final memo. Here is the three-year picture.
| Year | Mandatory MOOP, in-network | Mandatory MOOP, combined |
|---|
| 2025 | $9,350 | $14,000 |
| 2026 | $9,250 | $13,900 |
| 2027 | $9,850 | $14,800 |
The limits are not set by inflation or by a political decision. Under federal regulation 42 C.F.R. § 422.100(f)(4), CMS calculates them from projected Medicare fee-for-service out-of-pocket spending data. The mandatory limit is pegged to a high percentile of what traditional Medicare beneficiaries are projected to spend out of pocket, and the lower limit is pegged to a less extreme percentile. The intermediate band is simply the numeric midpoint between the two.
Because the input is a projection of actual fee-for-service spending, the number can move in either direction year to year. When the underlying spending projection dips, the cap dips, which is exactly what happened for 2026. For 2027, the projection rose.
CMS also applies a 10 percent cap on how much the in-network mandatory and lower MOOP limits can rise in a single year. In its 2027 memo, CMS noted that the projected figures did not hit that cap, so the 6.5 percent increase reflects the raw data rather than a ceiling override. The calculation also includes 100 percent of ESRD costs.
What Counts Toward Your Out-of-Pocket Maximum
This is where most people get burned. The MOOP is narrower than it sounds.
Counts toward the MOOP:
- Deductibles, copays, and coinsurance for Part A services (hospital, skilled nursing, home health)
- Deductibles, copays, and coinsurance for Part B services (doctor visits, outpatient care, lab work, durable medical equipment, Part B drugs)
- On PPOs, out-of-network Part A and Part B cost sharing counts toward the combined limit
Does NOT count toward the MOOP:
- Part D prescription drug cost sharing, even when your drug coverage is bundled into the same Medicare Advantage plan
- Your monthly plan premium
- Your Part B premium
- Supplemental benefits such as dental, vision, hearing, and fitness
- Anything the plan does not cover at all
- On HMOs, out-of-network care, which is generally not covered outside emergencies
That last exclusion on Part D is the one worth sitting with. A Medicare Advantage Prescription Drug plan gives you two separate caps, not one.
The Part D Cap Is Separate, and It Is Also Rising
For 2027, the Part D annual out-of-pocket threshold rises to $2,400, up from $2,100 in 2026. The standard Part D deductible rises to $700, up from $615.
| Part D parameter | 2026 | 2027 |
|---|
| Annual out-of-pocket threshold | $2,100 | $2,400 |
| Standard deductible | $615 | $700 |
Stack the two caps and the worst-case picture for a 2027 MA-PD enrollee looks like this: up to $9,850 in medical cost sharing plus up to $2,400 in drug cost sharing, for a theoretical maximum of $12,250 before premiums and before any supplemental benefits. On a PPO with heavy out-of-network use, the medical side alone could reach $14,800.
Very few people hit those numbers. But if you are managing a serious diagnosis, a transplant, a long hospitalization, or a specialty drug regimen, the combined figure is the one to plan around, not the headline MOOP.
What Plans Actually Set, Versus the Legal Ceiling
The $9,850 ceiling is a worst case that most plans do not use. Looking at the most recent full-year data available for 2026:
| Measure (2026, in-network) | Amount |
|---|
| Enrollment-weighted average MOOP, all plans | $5,421 |
| Average MOOP, HMO plans | $4,636 |
| Average MOOP, PPO plans | $6,592 |
| Average combined MOOP (in and out of network) | $9,825 |
| Legal maximum | $9,250 |
Source: KFF analysis of CMS Medicare Advantage landscape data.
Two things stand out. First, the typical enrollee's actual limit sits well below the cap, closer to $5,400 than $9,250. Second, the trend has been moving the wrong way for consumers. The median MOOP across plans rose from roughly $5,400 in 2025 to roughly $5,900 in 2026, an increase of about 9 percent, which outpaced the movement in the federal ceiling.
Since the 2027 ceiling rose 6.5 percent, plans now have more headroom than they had in 2026. Expect plan-level MOOPs to drift upward again for 2027, particularly on PPOs.
Plans Got a Payment Raise for 2027. That Cuts Both Ways.
CMS finalized the 2027 Rate Announcement on April 6, 2026 with a net average payment increase of 2.48 percent, worth more than $13 billion in additional payments to Medicare Advantage plans. That was a large jump from the 0.09 percent increase CMS had proposed in the January 2026 Advance Notice. The final estimate of the National Per Capita MA Growth Percentage came in at 4.40 percent, with the fee-for-service growth percentage at 5.46 percent.
More revenue to plans is not the same as lower costs to you. The MOOP ceiling still went up 6.5 percent, and plans are not required to pass payment increases through as richer benefits. Recent history is not encouraging: the 2026 plan year brought higher cost sharing and fewer plan choices in many counties even as the federal cap ticked down. Treat the payment increase as a reason plans may hold benefits steady, not as a guarantee your out-of-pocket exposure will fall.
Lower MOOP Plans Are Not Automatically Better
A plan that picks the lower MOOP band, capping you at $4,450 instead of $9,850, sounds like a clear win. There is a catch built into the regulation.
CMS permits plans with a lower MOOP to charge higher cost sharing on certain service categories, because the tighter overall cap limits the damage. A plan with a lower MOOP can, for example, charge more per day for a short inpatient stay than a plan sitting at the mandatory MOOP. The trade is real: you pay more per service, but you stop paying sooner.
Which structure wins depends entirely on how much care you use. If you have a light year, the mandatory-MOOP plan with low copays likely costs you less. If you have a heavy year, the lower-MOOP plan caps your downside hundreds or thousands of dollars earlier. Do not shop on the MOOP number alone.
How to Check and Compare Your 2027 MOOP
Plan-specific 2027 details become public in early October 2026, ahead of the Annual Enrollment Period.
- Note the key dates. Medicare Advantage Annual Enrollment runs October 15 to December 7, 2026, for coverage starting January 1, 2027. The Medicare Advantage Open Enrollment Period runs January 1 to March 31, 2027, if you need to switch after the fact.
- Read your Annual Notice of Change. Your current plan must mail you an ANOC by September 30, 2026. It states your 2027 MOOP directly. Compare it line by line against your 2026 figure, because this is the single fastest way to spot an increase.
- Use the official Plan Finder. Go to medicare.gov/plan-compare, enter your ZIP code and your prescriptions, and compare plans side by side. The tool displays each plan's in-network and combined out-of-pocket maximum.
- Check both MOOP numbers on any PPO. The in-network figure is the one plans advertise. The combined figure is the one that applies if you see an out-of-network specialist. On a PPO, always look at both.
- Estimate your realistic spending, not the worst case. Add up your expected specialist visits, imaging, procedures, and hospital risk. A plan with a $7,000 MOOP and low copays can easily beat a plan with a $4,500 MOOP and high copays if you rarely use care.
- Price the drug side separately. Your Part D costs run on their own $2,400 track in 2027. Run your actual medication list through Plan Finder rather than assuming.
- Call 1-800-MEDICARE or your SHIP. State Health Insurance Assistance Programs give free, unbiased counseling and are not paid on commission.
Frequently Asked Questions
What is the Medicare Advantage out-of-pocket maximum for 2027?
The mandatory maximum is $9,850 for in-network Part A and Part B services. For PPO plans that cover out-of-network care, the combined in-network and out-of-network maximum is $14,800. CMS finalized these figures in April 2026. Individual plans may set lower limits, and most do.
Is the 2027 MOOP still just a projection?
No. Early searches for "2027 projections" made sense in late 2025 and early 2026, when only estimates existed. CMS published the final CY 2027 Part C MOOP limits on April 22, 2026. The $9,850 and $14,800 figures are final, not forecasts.
How much did the Medicare Advantage out-of-pocket maximum increase for 2027?
The in-network cap rose $600, from $9,250 in 2026 to $9,850 in 2027, an increase of about 6.5 percent. The combined cap rose $900, from $13,900 to $14,800.
Do prescription drug costs count toward the Medicare Advantage out-of-pocket maximum?
No. Part D drug cost sharing never counts toward your Medicare Advantage MOOP, even when the drug coverage is part of the same plan. Part D has its own separate cap, which is $2,400 in 2027.
What is the lowest possible Medicare Advantage out-of-pocket maximum in 2027?
There is no federal floor. A plan may set a MOOP of $0 in theory, and plans in the "lower MOOP" band must stay at or below $4,450 in-network. In practice, the lowest widely available limits tend to land in the $3,000 to $4,500 range, most often on HMO plans.
Does the out-of-pocket maximum include my premiums?
No. Neither your Medicare Advantage plan premium nor your Part B premium counts toward the MOOP. The limit applies only to cost sharing on covered Part A and Part B services.
Why do HMO plans usually have lower out-of-pocket maximums than PPOs?
HMOs restrict you to a defined network, which gives the plan more control over costs and lets it offer a tighter cap. In 2026, the average HMO in-network MOOP was $4,636 versus $6,592 for PPOs. The PPO premium buys you out-of-network flexibility, and you pay for it in a higher ceiling.
Does Original Medicare have an out-of-pocket maximum?
No. Original Medicare (Parts A and B) has no annual out-of-pocket limit. This is the core structural advantage Medicare Advantage plans hold, and it is why the MOOP figure gets so much attention. People who stay in Original Medicare typically buy a Medigap policy to cap their exposure instead.
When will I know my specific plan's 2027 out-of-pocket maximum?
Your plan must send you an Annual Notice of Change by September 30, 2026, listing your 2027 MOOP. Full plan data for all available plans posts to medicare.gov in early October 2026, before Annual Enrollment opens on October 15.
