Average MA out-of-pocket maximum by plan type U.S. 2022

For 2022, the maximum out-of-pocket (MOOP) amount a Medicare Advantage beneficiary will pay is 5,153 U.S. dollars. This is nearly a third less than the MOOP limit set by the Centers for Medicare & Medicaid Services that year, which was 7,550 U.S. dollars. MOOP is the most a beneficiary must pay out-of-pocket (including deductibles, co-pays and co-insurance) for covered services in a plan year. This statistic shows the average Medicare Advantage maximum out-of-pocket amount for 2022, by plan type (in U.S. dollars).

Average Medicare Advantage (MA) maximum out-of-pocket (MOOP) amount in the U.S. for 2022, by type of plan (in U.S. dollars)

Characteristic	MOOP amount in U.S. dollars
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Release date

August 2022

More information

Region

United States

Survey time period

2022

Supplementary notes

PACE, Special Needs Plans, Part B–only plans, employer-sponsored plans, and plans under sanction are excluded.
Each year, the Centers for Medicare and Medicaid Services (CMS) sets a Medicare Advantage (MA) maximum out-of-pocket (MOOP) limit to reduce beneficiary financial risk. Beneficiary cost-sharing for Part A and Part B services is waived once a beneficiary reaches the MOOP amount. The CMS-allowed MOOP limit provides a ceiling for MA plans’ MOOP limits, and plans may choose to set a lower limit. CMS has set the in-network, maximum out-of-pocket limit at $7,550 per year, up from the $6,700 limit set for 2010 to 2020.

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