Medicare Advantage costs, explained
What you pay, where it comes from, and the one number worth knowing before you need care.
What is MOOP?
Your most important number may be your MOOP
MOOP means Maximum Out-of-Pocket.
A Medicare Advantage plan has an annual limit on what you pay for covered Medicare Part A and Part B services under the plan. Once you reach the applicable limit for covered services, the plan generally pays 100% of covered services for the remainder of the calendar year.
Educational visualization only. Not a personalized financial prediction.
Looking ahead
Projected Medicare costs 2027
Projections for the coming plan year. Final 2027 amounts are published by CMS each fall and may differ.
Part B premium
$209.50
per month
Projected standard monthly Medicare Part B premium
Source: CMS projectionPart B deductible
$292.00
Projected annual Part B deductible. Medigap plans can cover this deductible.
Source: CMS projectionPart D deductible
Up to $700
Maximum projected Part D prescription drug deductible a plan may charge
Source: CMS projectionPart D out-of-pocket cap
$2,400
Projected annual cap on Part D prescription drug out-of-pocket costs
Source: CMS projectionThe national picture
National averages for Medicare Advantage
How Medicare Advantage cost limits and premiums compare nationwide. Averages vary by state, county and carrier.
Average national out-of-pocket limit, in-network
$5,421
$4,636 for HMOs and $6,592 for PPOs, while combined in- and out-of-network limits for PPOs average $9,825.
Network structure & cost limits
HMO in-network limit
$4,636
average per year
Average annual in-network out-of-pocket limit across HMO plans.
PPO in-network limit
$6,592
average per year
Average annual in-network out-of-pocket limit across PPO plans.
Federal in-network cap
$9,250
maximum allowed
Federal law caps the in-network out-of-pocket limit a plan can set.
Out-of-network & combined limits
PPO combined limit
$9,825
average per year
Average combined in-network and out-of-network limit across PPO plans.
HMO out-of-network
$0 coverage
HMO plans generally cover no non-emergency out-of-network care.
Combined cap ceiling
$13,900
maximum allowed
Federal ceiling on combined in-network and out-of-network limits.
Premiums & extra costs
Zero-premium plans
75%
of enrollees
Share of Medicare Advantage enrollees who pay no supplemental plan premium.
Average premium
$15
per month
Average supplemental PPO/HMO premium among plans that charge one.
Part D Rx cap
$2,400
in 2027
The prescription drug out-of-pocket cap rises to $2,400 in 2027.
National averages and federal caps for educational comparison. Your plan's exact limits, networks and premiums are set by the carrier and listed in plan documents.
2026/2027 reality check
The Medicare Advantage landscape is changing
Low premiums have become a major attraction of Medicare Advantage. But a low premium doesn't mean low exposure when healthcare is actually used.
$9,250
Highest in-network out-of-pocket limit a plan may use
55%
Share of eligible Medicare beneficiaries enrolled in Medicare Advantage
32
Average number of Medicare Advantage prescription drug plans available to a beneficiary
19%
Share of Medicare Advantage enrollees whose in-network out-of-pocket limit exceeds $7,000
Cost exposure map
Where Medicare Advantage costs actually show up
Select an area of care to see what can drive cost-sharing. Your actual cost depends on your specific Medicare Advantage plan.
Hospital
Potential inpatient cost-sharing
Many Medicare Advantage plans apply a per-day copay for the first several days of an inpatient stay, and some apply coinsurance. A longer stay, or more than one stay in a year, can add up quickly.
Your actual cost depends on your specific Medicare Advantage plan.
Check my planWhat could happen?
Walk through a realistic year
Educational scenarios, not a quote, guarantee of benefits, or prediction of actual healthcare expenses.
Routine healthcare year
Primary care visits, preventive services and a few prescriptions. Cost-sharing is typically modest, but specialist and imaging copays still apply.
A qualifying supplemental policy may provide a fixed benefit that could help offset certain expenses, subject to the policy terms. Benefit figures appear only once actual policy information has been configured for your state and product.
Don't wait until you're in the hospital to discover your costs.
A plan can look inexpensive until you actually need significant healthcare. Knowing your plan's rules, network, cost-sharing and out-of-pocket maximum ahead of time can help you make more informed decisions.
Know your plan · Know your exposure · Know your options