Do Medicare Supplement plans have an out-of-pocket maximum like Medicare Advantage plans do?

Question

Ashley Broussard · Accepted Answer

Most Medicare Supplement (Medigap) plans do not have an annual out-of-pocket maximum like Medicare Advantage plans do. However, that doesn't necessarily mean you'll pay more out of pocket with a Medicare Supplement.

The two types of coverage work differently.
Medicare Advantage vs. Medicare Supplement

Medicare Advantage (Part C) plans have an annual maximum out-of-pocket (MOOP) limit for covered Medicare Part A and Part B medical services. Once you reach that limit, the plan pays 100% of covered medical costs for the remainder of the calendar year. Monthly premiums, prescription drug costs, and noncovered services generally don't count toward that limit.

Medicare Supplement (Medigap) plans work alongside Original Medicare to help pay expenses such as deductibles, copayments, and coinsurance. Depending on the supplement plan you choose, you may have very little out-of-pocket expense for Medicare-covered services. 

Are there any exceptions?
Yes! Medicare Supplement Plans K and L have annual out-of-pocket limits.

Plan K - $8,000
Plan L - $4,000
Plans F, G, N and most others - No formal annual limit

Glori Gold · Answer

Most Medicare Supplement (Medigap) plans do not have an annual out-of-pocket maximum like Medicare Advantage plans. However, Medigap helps cover certain costs that Original Medicare doesn’t pay, such as deductibles, copayments, and coinsurance, depending on the plan. Plans K and L are exceptions because they have annual out-of-pocket limits. Medicare Advantage plans have a required annual out-of-pocket maximum for covered Part A and Part B services, but prescription drug costs and monthly premiums generally do not count toward that limit.

Important: Popular Medigap plans such as Plan G and Plan N do not have a formal annual out-of-pocket maximum, although they can significantly reduce Medicare-covered medical expenses.

Elijah Pannell · Answer

No for the most part. Medicare Supplement (Medigap) plans do not have annual out-of-pocket maximums like Medicare Advantage plans. Medigap works by covering many of Medicare's deductibles, copays, and coinsurance, which can leave you with very little cost-sharing depending on the plan you choose.

Answered by Elijah Pannell on October 20, 2026

Agent Licensed in CA, MI, NJ & TX

Answered by Elijah Pannell Medicare Insurance Agent

Christopher Horan · Answer

Generally, no—most standard Medigap plans do not have a formal "Out-of-Pocket Maximum" (MOOP) written into the policy, but they don't need one because of how they work.

Whereas Medicare Advantage plans are required by law to set an annual out-of-pocket spending limit (up to $9,250 for in-network care in 2026), Medigap plans provide financial protection using a completely different mechanism.

WyeTony Cribbs · Answer

A Supplement Medicare plan does not have a maximum out of pocket like Medicare Advantage does. A Supplement Medicare plan pays most out of pocket costs that Original Medicare does  cover.

David Resnik · Answer

Medicare Supplement plans do not offer any medical coverage on their own. 

They SUPPLEMENT coverage under Original Medicare, which has no out-of-pocket maximums.

Your provider bills Medicare, then Medicare bills the Supplement plan. You really don't interact with the Supplement plan at all! If Medicare approves an expense, then the Supplement can pay. If Medicare disallows something, so will the Supplement plan.

Andrew Kelly · Answer

The two main plans in 2026/7 are the "G" plan and "N" plan. With the "G" plan there isn't any out of pocket other than your Part B annual deductible. Medicare A/B pays 80% and your supplement pays 20%. There are no co-pays with the "G" plan. With the "N" plan it functions exactly like the "G" plan except there is a $20 co pay for doctor visits and $50 co pay for ER visits (so long as you AREN'T admitted).

Answered by Andrew Kelly on October 26, 2026

Agent Licensed in WA & OR

Answered by Andrew Kelly Medicare Insurance Agent

Scott VanHoogstraat · Answer

No. Once you pay your Annual deductible everything should be covered in Part A and B. Keep an eye on the website of the Insurer you went with

Juliette Chihade · Answer

Medicare Advantage plans has out-of-pocket maximum (MOOP) but not Medicare supplement plans . 
Medicare supplement plans might have deductibles and co-pays.

Latonya Dawson · Answer

Short answer: mostly no — but for a reason that actually favors Medigap, not against it. Here's how it breaks down:

Do Medicare Supplement plans have an out-of-pocket maximum like Medicare Advantage plans do?

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Do Medicare Supplement plans have an out-of-pocket maximum like Medicare Advantage plans do?

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