Medicare Advantage MOOP: What to Watch for in 2026

If you’re on Medicare Advantage, you’ve probably seen the term Maximum Out-of-Pocket (MOOP).
But do you know how high it can go in 2026 — and what that means for your wallet?

Let’s break it down in plain English.

What is a MOOP (and why does it matter)?

Every Medicare Advantage plan comes with a Maximum Out-of-Pocket limit.
It’s the cap on what you could spend in a calendar year for covered medical services.

Think of it as your financial “worst-case” ceiling:

• Once you hit the MOOP, the plan pays 100% of covered medical costs for the rest of the year.
• Until then, you’re on the hook for co-pays, deductibles, and coinsurance.

If you have a rough health year — say multiple hospital stays or an expensive surgery — the MOOP keeps you from going broke.

Who decides the MOOP?

Here’s the insider scoop: Medicare sets the maximum, but carriers decide where to set it inside that range.

So yes, plans can set a lower MOOP… but most don’t. Rising costs mean carriers often push their limits higher, not lower.

What’s happening in 2026?

Big changes. CMS has announced that in 2026, MOOPs are rising alongside other shifts like Medicare Service Area Reductions.

• In-network MOOP maximum: $9,850
• Combined in- and out-of-network MOOP maximum: $14,750

That’s a jump of nearly $1,500 more exposure than today.

Translation: if your health takes a bad turn, you could be on the hook for almost
$10,000 in 2026 before your plan picks up everything.

Will plans actually hit the max?

Some will. Not every plan goes straight to the ceiling, but many creep close.
Even if your MOOP doesn’t max out, expect upward movement.

Why?

• Medical costs keep rising.
• Carriers are tightening networks and raising cost-sharing.
• CMS rules give plans the room — and they’re using it.

How to protect yourself

Don’t just look at the shiny $0 premium ads. The real cost control is hidden in your
Annual Notice of Change (ANOC), which arrives by September 30 each year.

When you get it, dig in and check:

• What’s my MOOP for 2026?
• How close is it to the $9,850 max?
• Can I realistically handle that “worst-case” cost if I get sick?

If that number makes you sweat, it may be time to compare other coverage paths, including Medigap.

The bottom line

MOOPs don’t get the headlines, but they should. Carriers will keep advertising $0 premiums and extras, while quietly raising the one number that really protects you: your MOOP.

Don’t toss your ANOC or ignore Medicare Advantage termination letters — they can completely change your coverage in 2026.

Make sure you know your 2026 worst-case scenario before AEP (Oct 15–Dec 7).