Here's the short answer. Original Medicare has no yearly limit on what you pay out of pocket. Medicare Advantage plans do have a yearly limit. Once you reach your plan's limit, the plan pays 100% of your covered health services for the rest of the calendar year. The limit is set by each plan, so it is not the same for everyone. Your drug plan has its own separate yearly cap.
Original Medicare: no yearly limit
In Original Medicare, you pay deductibles, copayments, and coinsurance. Most Part B services cost 20% of the Medicare-approved amount after you pay the deductible.
The same page says there is no limit on what you pay out of pocket, unless you have other coverage. The most common kinds of other coverage are:
- A Medigap policy, which helps pay your share of costs.
- A Medicare Advantage plan, which has its own yearly limit.
- Employer, retiree, or union coverage, or Medicaid.
Medicare Advantage: a yearly limit that varies by plan
Medicare Advantage plans cap what you pay for covered services. The limit varies by plan. Some plans have different limits for in-network and out-of-network care. If you use only in-network providers, the in-network limit is the one that matters. Check your plan's rules before you go out of network.
The limit applies to the Part A and Part B services your plan covers. Once you reach it, you pay nothing more for those services that year. Two things to keep in mind:
- It resets each year. The limit runs on the calendar year.
- It is not a promise of low costs. You can pay a lot before you reach the limit. Compare the copayments and coinsurance too. See Medicare plan comparison for 2027.
Plan limits can change from year to year. Always read the number for the year you are choosing. See Medicare costs in 2027 for the official 2027 figures we have verified.
Side by side
| Coverage | Yearly out-of-pocket limit? |
|---|---|
| Original Medicare (Parts A and B) | No limit on its own. |
| Medicare Advantage plan | Yes. It varies by plan. |
| Medigap Plan K or Plan L | Yes. Plan K's limit is $8,000 and Plan L's is $4,000 in 2026. |
| Other Medigap plans | No separate limit. They pay a set share of your costs. |
| Part D drug coverage | Yes. A separate cap on covered drugs. |
The drug cap is separate
Drug costs have their own cap. It is separate from the medical limit in a Medicare Advantage plan. In 2026, the Part D cap is $2,100. In 2027, it is $2,400. It includes your deductible, your spending, and certain payments made for you, like through the Extra Help program.
Most Medicare Advantage plans include drug coverage. If yours does, the drug cap still applies on its own. See Part D for how the drug stages work.
How people cap their costs
These are the main ways to limit what you could owe. MediPrimer does not say which is best. The right fit depends on your health, your budget, and the doctors you use. See Choosing Coverage and Plan Types.
- Join a Medicare Advantage plan. The plan's yearly limit caps your covered Part A and Part B costs.
- Add a Medigap policy to Original Medicare. Medigap helps pay your share of costs. Read the Medigap guide and the rules on buying Medigap later.
- Use other coverage you already have. This could be employer, retiree, or union coverage, or Medicaid.
- Ask about help with costs. If your income is limited, a Medicare Savings Program or Extra Help may lower your costs.
If you are choosing a plan this fall, see Medicare Open Enrollment 2027 for dates and a checklist.
Common questions
Does Original Medicare have an out-of-pocket maximum?
No. There is no yearly limit on what you pay out of pocket in Original Medicare, unless you have other coverage like Medigap or a Medicare Advantage plan.
Does every Medicare Advantage plan have the same limit?
No. The yearly limit varies by plan. Check your own plan's number in its letter or in Plan Finder.
What happens when I reach my plan's limit?
The plan pays 100% of your covered health services for the rest of the calendar year.
Is there a cap on Medicare drug costs?
Yes. Part D has a yearly cap on drug costs, and it changes each year. See the official Medicare Part D costs page for the current number.