Original Medicare has no yearly limit on what you pay for Part A and Part B care. Medicare Advantage has a limit for covered medical services, and Part D has a separate limit for covered drugs. An out-of-pocket maximum is the most you must pay for the covered costs that count toward that limit in a year.

Original Medicare

Original Medicare has no annual cap on what you pay for Part A and Part B. Repeated hospital benefit periods, 20% Part B coinsurance, and other cost-sharing can continue throughout the year.

Medigap, Medicaid, or employer or retiree insurance may pay some of those costs, depending on the coverage.

Medicare Advantage

Every Medicare Advantage plan has a yearly out-of-pocket limit for covered Part A and Part B services. Once spending that counts reaches the plan's limit, the plan pays 100% of covered medical services for the rest of the calendar year.

The amount varies by plan. A PPO may show separate in-network and combined in- and out-of-network limits. If you use providers both inside and outside the network, check the combined limit as well as the in-network limit. Even after you reach a limit, you must still follow the plan’s coverage, network, medical-need, and approval rules.

What May Not Count?

Do not assume every dollar counts toward the medical limit. The Part B premium, any plan premium, Part D prescription costs, noncovered care, and some extra-benefit expenses generally do not count toward the Part A and Part B maximum.

Part D has a separate prescription drug out-of-pocket cap. In 2026, that cap is $2,100 for covered Part D drugs.

Read the Evidence of Coverage, the document explaining your plan’s benefits and rules, for its exact limit and the expenses that count.

For example, suppose you pay $2,434.80 in standard Part B premiums in 2026, reach a plan’s $5,000 medical limit, and have $2,100 in qualifying Part D spending. Your total would be $9,534.80. This made-up example assumes no financial assistance, premium rebate, income adjustment, or additional plan premium. Noncovered bills and extra-benefit charges can add more, and if you use out-of-network care in a PPO, you may need to use its combined limit instead.

The $2,100 drug figure is for 2026; the 2027 Part D threshold is $2,400. Use the plan’s Evidence of Coverage and the matching coverage year’s drug rules when making your own calculation.

Medicare policy sources last checked: October 8, 2026.