MOOP is the maximum amount you pay for covered health care services in one plan year. Once you reach this limit, your plan pays 100% of the remaining covered costs. Not all Medicare plans include a maximum out-of-pocket limit. MOOP generally includes deductibles, copayments, and coinsurance, but it does not include monthly premiums, balance-billing charges, non-covered services such as cosmetic procedures, or supplemental benefits such as routine dental, vision, or hearing care. Costs for out-of-network providers do not count toward the in-network MOOP, but they may count toward the out-of-network MOOP.
Original Medicare (Parts A and B): Does not have an annual out-of-pocket maximum, meaning your potential medical costs can be unlimited without extra insurance. If you are hospitalized several times during the year, have a Chronic condition like diabetes, heart disease or kidney failure and/or have a lot of medical expenses, you may end up paying a lot of money each year due to the costs associated with Original Medicare such as: The Part A and Part B Deductibles – Your Part B Premium – Your 20% Part B coinsurance (Medicare only pays 80%) – Any Part A coinsurance for extended (over 60 or 90 days) in-patient hospital stays.
Medicare Advantage (Part C): Required by federal law to have an annual maximum out-of-pocket limit for in-network (and combined out-of-network) services. In 2026 the max out-of-pocket limit can’t exceed $9,250 for in-network services, and $13,900 for in and out-of-network services, though individual Medicare Advantage plans can set lower limits.
Medicare Part D (Prescription Drugs): Has an annual out-of-pocket spending cap of $2,100 in 2026 and $2,400 in 2027.
Medigap (Medicare Supplement Insurance): Most traditional Medigap Policies do not have a maximum out-of-pocket limit because they cover most standard out-of-pocket costs. However specific plans like Plan K and Plan L do feature annual out-of-pocket caps, $8,000 and $4,000 respectively.
So, without a maximum limit on your yearly out of pocket costs, you won’t be protected from excessive costs if you need a lot of care or expensive treatments.
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