A new Avalere analysis, conducted on behalf of Better Medicare Alliance, finds that the national median maximum out-of-pocket cost will increase nearly $1,000 in the next two years as plan options shrink.
Seniors who enroll in Medicare Advantage plans in 2026 will face higher out-of-pocket cost limits and fewer plan options in 2026, even as premiums remain stable, according to a new analysis of Centers for Medicare & Medicaid Services (CMS) 2025 Medicare Advantage Landscape File data.
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The report was conducted by Avalere for Better Medicare Alliance, a research and advocacy group that supports Medicare Advantage.
While the Medicare Advantage program remains strong overall, the Avalere report indicates that emerging trends could signal future challenges for beneficiaries if current pressures persist. Specifically, the increase of the median maximum out-of-pocket limit (MOOP) for the second year in a row reflects a “steady erosion of the program’s affordability advantage under mounting policy and financial pressure,” the analysis found.
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Among the key findings:
- Rising out-of-pocket limits: The national median MOOP will increase from $5,400 in 2025 to $5,900 in 2026—a 9.3 percent rise and nearly a $900 increase over two years.
- Fewer plan choices: There will be 335 fewer non–special needs plans offered in 2026, continuing a two-year trend of shrinking plan availability.
- Fewer plans offering lower MOOPs: Eleven percent fewer plans will offer MOOPs below the CMS limit in 2026.
- Premiums stable, affordability pressure rising: While 59 percent of offerings remain $0-premium, higher MOOPs, fewer sub-limit MOOP options, and fewer overall plan choices mean beneficiaries may still face higher costs when they need care and fewer avenues to find lower-cost options.
“For the second year in a row, seniors are being asked to pay more for their health care while having fewer choices. That’s not sustainable,” said Mary Beth Donahue, president and CEO of the Better Medicare Alliance in the study announcement. “Even with stable premiums, rising out-of-pocket costs and shrinking plan options make it harder for seniors to access care when they need it most. These challenges stem from continued policy and funding changes in the previous administration — and they show why we must protect Medicare Advantage and ease pressure on the program, not threaten it with further cuts.”