Original Medicare (Part A and Part B) has no out-of-pocket maximum. There is no yearly limit on what you pay for hospital and doctor care, and that is still true in 2027. Medicare.gov says it plainly: "There's no yearly limit on what you pay out-of-pocket, unless you have supplemental coverage." The only caps come from other coverage: a Medicare Advantage plan must cap in-network costs at no more than $9,850 in 2027, Part D drug costs are capped at $2,400 in 2027, and Medigap (Medicare Supplement) policies pay most or all of the gaps Original Medicare leaves.
Choosing how to cover that missing cap is the main decision people make during Medicare open enrollment, which runs October 15 to December 7, 2026 for 2027 coverage.
The Short Answer by Type of Coverage
| Coverage | Yearly out-of-pocket cap on hospital and doctor care | 2027 figure |
|---|
| Original Medicare (Part A and B) alone | None | No limit |
| Original Medicare plus Medigap Plan K | Yes, set by federal rules | $8,360 |
| Original Medicare plus Medigap Plan L | Yes, set by federal rules | $4,180 |
| Original Medicare plus Medigap Plan G | No formal cap, but the policy pays nearly all covered costs after the Part B deductible | Part B deductible only (2027 amount not yet published; $283 in 2026) |
| Medicare Advantage, in-network | Yes, the legal ceiling | $9,850 or less (each plan sets its own) |
| Medicare Advantage PPO, in and out of network combined | Yes, the legal ceiling | $14,800 or less |
| Part D prescription drugs (standalone or inside an Advantage plan) | Yes, applies automatically | $2,400 |
Sources: Medicare.gov "Medicare costs" page; CMS Final Contract Year 2027 Part C bid review standards, Table 3; CMS CY2027 Rate Announcement, Table V-2; CMS CY2027 Medigap Plans K and L out-of-pocket limits notice. Premiums do not count toward any of these caps.
Why Original Medicare Has No Cap
Original Medicare was designed in 1965 around deductibles and coinsurance, and Congress never added an annual limit. So once you meet your deductibles, you keep paying your share for as long as you keep getting care.
Here is what that share looks like with the official 2026 amounts. CMS has not yet published the 2027 Part A and Part B premiums and deductibles. It usually announces them in mid-November, so the figures below are the ones in force through December 31, 2026.
Part A (hospital) costs in 2026
| What you pay | 2026 amount |
|---|
| Inpatient hospital deductible, per benefit period | $1,736 |
| Hospital days 1 to 60 | $0 after the deductible |
| Hospital days 61 to 90 | $434 a day |
| Lifetime reserve days (up to 60 over your lifetime) | $868 a day |
| After lifetime reserve days are used | All costs |
| Skilled nursing facility days 1 to 20 | $0 |
| Skilled nursing facility days 21 to 100 | $217 a day |
| Skilled nursing facility after day 100 | All costs |
Source: CMS fact sheet "2026 Medicare Parts A & B Premiums and Deductibles" and Medicare.gov.
The Part A deductible is charged per benefit period, not per year. A benefit period ends after you have been out of the hospital or skilled nursing facility for 60 days in a row. If you are admitted, go home for a month, and are admitted again, you are still in the same benefit period. But two separate hospital stays several months apart can mean paying the $1,736 deductible twice in one year.
Part B (doctor and outpatient) costs in 2026
| What you pay | 2026 amount |
|---|
| Standard monthly premium | $202.90 |
| Annual deductible | $283 |
| Coinsurance after the deductible | 20% of the Medicare-approved amount, with no limit |
| Excess charges from doctors who do not accept assignment | Up to 15% above the Medicare-approved amount |
The 20% coinsurance is where costs can climb without stopping. It applies to doctor visits, outpatient surgery, chemotherapy given in a clinic, dialysis, durable medical equipment, and many other services. There is no point in the year where it switches off.
What No Cap Can Cost: Two Examples
These are illustrations using 2026 amounts, not quotes. Your actual costs depend on the Medicare-approved amounts for your care.
A long hospital stay. Someone with Original Medicare alone is in the hospital for 90 days in one benefit period. They pay the $1,736 deductible plus 30 days at $434, which is $13,020. Total: $14,756, before any doctor bills from the stay, which fall under Part B.
A year of outpatient cancer treatment. Someone has $50,000 in Medicare-approved Part B charges for infusions and specialist visits. They pay the $283 deductible, then 20% of the remaining $49,717, which is $9,943.40. Total: $10,226.40. If treatment continues the next year, the bill starts again.
In both cases, the same care under a Medicare Advantage plan could not cost more than the plan's in-network limit for covered services, and under Medigap Plan G the person would owe little beyond the Part B deductible.
The 2027 Caps That Do Exist
Medicare Advantage maximum out-of-pocket (MOOP)
Every Medicare Advantage plan must have a yearly limit on what you pay for covered Part A and Part B services. CMS sets the highest limit a plan may use. For 2027:
| Limit | 2026 | 2027 |
|---|
| In-network ceiling | $9,250 | $9,850 |
| Combined in-network and out-of-network ceiling (PPOs) | $13,900 | $14,800 |
Most plans set their own limit below the ceiling. A BenefitsUSA count of the 2027 plan files found the typical (median) in-network limit on a regular Advantage drug plan is $6,500 in 2027, up from $5,900 in 2026. See why most Advantage plans raised their limit for 2027 and our full 2027 MOOP tables by plan type.
The MOOP does not include your monthly premiums (the plan's or Part B's), Part D drug costs, or most extra benefits such as dental and vision. Out-of-network care on an HMO usually is not covered at all, so it does not count.
Part D drug cap
The Part D out-of-pocket cap is $2,100 in 2026 and $2,400 in 2027. It applies to everyone with Part D, whether you get drugs through a standalone plan alongside Original Medicare or through a Medicare Advantage plan. Once you reach it, you pay nothing more for covered drugs that year. You do not have to apply. Premiums do not count toward it.
So the one place Original Medicare enrollees do have a cap is drugs, and only if they have Part D coverage.
Medigap Plans K and L
Two Medigap plans have a written out-of-pocket limit. Plan K pays 50% of most cost sharing and Plan L pays 75%, until you reach the limit. After that, the plan pays 100% of covered Part A and Part B cost sharing for the rest of the year.
| Plan | 2026 limit | 2027 limit |
|---|
| Medigap Plan K | $8,000 | $8,360 |
| Medigap Plan L | $4,000 | $4,180 |
The high-deductible versions of Plans F and G have a $3,050 deductible in 2027, up from $2,950 in 2026. After you pay that, the policy covers the rest of your covered costs.
How Medigap Fills the Gap Without a Formal Cap
Most Medigap plans do not advertise an out-of-pocket maximum because they do not need one. They pay the deductibles and coinsurance directly, so the bill never builds up.
| Plan | Part A deductible | Part A coinsurance and 365 extra hospital days | Part B deductible | Part B 20% coinsurance | Part B excess charges |
|---|
| G | Covered | Covered | Not covered | Covered | Covered |
| N | Covered | Covered | Not covered | Covered, except copays up to $20 for some office visits and up to $50 for some ER visits | Not covered |
| K | 50% | Covered | Not covered | 50% | Not covered |
| L | 75% | Covered | Not covered | 75% | Not covered |
Plans C and F also pay the Part B deductible, but only people who became eligible for Medicare before January 1, 2020 can buy them. Our 2027 Medigap comparison chart covers all 10 standardized plans.
The trade-off is cost. You pay a Medigap premium every month on top of Part B, and a Medigap policy does not include drug coverage, so most people add a separate Part D plan. With Medicare Advantage you often pay a lower premium, but you accept networks, prior authorization, and copays that add up until you hit the plan's limit.
Choosing Between Medigap and Medicare Advantage for 2027
These are the steps that decide it, in order.
- Check whether you can still buy Medigap without health questions. Your Medigap open enrollment period is the 6 months starting the month you are 65 or older and enrolled in Part B. During it, an insurer must sell you any plan it offers at its standard rate, even with health conditions. After it ends, in most states an insurer can ask health questions, charge more, or turn you down. A few states give extra rights, so check with your State Health Insurance Assistance Program (SHIP).
- Know your trial rights. If you join a Medicare Advantage plan when you first become eligible at 65 and leave within the first 12 months, you have a federal right to buy a Medigap policy. If you drop a Medigap policy to try Advantage for the first time, you can generally return to that policy (or a similar one) within 12 months.
- Add up your worst year. For Advantage, that is 12 months of premium plus the plan's in-network limit. For Medigap, it is 12 months of the Medigap premium plus what the plan does not cover (for Plan G, the Part B deductible). Add Part D for both.
- Check your doctors and hospitals. Medigap works with any provider in the country that accepts Medicare. An Advantage plan's limit only protects you fully inside its network.
- Look at the plan's 2027 Annual Notice of Change if you already have Advantage. Six in ten returning Advantage drug plans raised their limit for 2027.
- Make changes by December 7, 2026. Advantage and Part D changes made during open enrollment start January 1, 2027. Advantage members get one more chance to switch plans or move to Original Medicare from January 1 to March 31, 2027.
Free, unbiased counseling is available from your state SHIP, at shiphelp.org, and from 1-800-MEDICARE.
Help If You Cannot Afford the Gaps
If your income and savings are limited, a Medicare Savings Program may pay part or all of your Medicare costs. The Qualified Medicare Beneficiary (QMB) program pays Part A and Part B premiums, deductibles, and coinsurance, which removes the no-cap problem for covered services. Providers cannot bill QMB members for Medicare cost sharing. See Medicare Savings Program income limits. People who qualify for full Medicaid alongside Medicare also get most cost sharing covered. Extra Help lowers Part D costs further.
Frequently Asked Questions
Does Medicare have an out-of-pocket maximum?
Not Original Medicare. Parts A and B have no yearly limit on what you pay. Medicare Advantage plans must have a limit, no higher than $9,850 in-network in 2027, and Part D has a $2,400 drug cap in 2027.
What is the Medicare out-of-pocket limit for 2027?
There is no 2027 limit for Original Medicare. The 2027 limits that exist are the Medicare Advantage ceilings ($9,850 in-network, $14,800 combined), the Part D cap ($2,400), and the Medigap Plan K and L limits ($8,360 and $4,180).
Does the Part D $2,400 cap apply if I have Original Medicare?
Yes, if you have a Part D plan. The cap applies to covered drugs under any Part D coverage, standalone or within an Advantage plan. It does not cover hospital or doctor bills.
Do premiums count toward the out-of-pocket maximum?
No. Part B premiums, Medicare Advantage plan premiums, Medigap premiums, and Part D premiums do not count toward any Medicare cap.
Is Medigap Plan G the same as having an out-of-pocket maximum?
Close to it for covered services. After you pay the Part B deductible ($283 in 2026), Plan G pays the rest of your Medicare-covered cost sharing, including excess charges. You still pay the monthly premium, and it does not cover services Medicare does not cover.
Has CMS published the 2027 Part B premium and deductible?
Not as of November 4, 2026. CMS usually announces them in mid-November. Until then, the official figures are the 2026 ones: a $202.90 standard premium and a $283 deductible.
Can I switch from Medicare Advantage to Original Medicare and buy Medigap later?
You can switch to Original Medicare during open enrollment (October 15 to December 7) or from January 1 to March 31. Buying Medigap afterward is the harder part. Unless you are in a trial period or have another guaranteed right, insurers in most states can review your health and decline you.
This article is general information, not insurance or legal advice. Plan costs and rules vary by plan and state.
