Medicare glossary
Out-of-Pocket Maximum
An out-of-pocket maximum is the most you'll pay for covered care in a year; once you reach it, the plan pays 100% of covered costs. Medicare Advantage plans have one for medical care, and Part D has one for drugs.
In 2026, Medicare Advantage plans cap in-network medical costs at no more than $9,250, and Part D caps covered drug costs at $2,100. Original Medicare on its own has no out-of-pocket maximum, which is why a Medicare Supplement (to limit cost-sharing) is often paired with it.
Ready to compare?
Ready to compare real Medicare plans?
Enter your ZIP and we’ll take you to PlanMatch Medicare to compare the 2026 plans available where you live.