2027 Out-of-Pocket Limits at a Glance
Where there are two numbers, the first is for one person (self-only) and the second is for a family.
| Plan type | 2026 | 2027 |
|---|---|---|
| ACA plans (Marketplace and most job-based plans), in network | $10,600 / $21,200 | $12,000 / $24,000 |
| HSA-eligible high deductible plan (HDHP), out-of-pocket maximum | $8,500 / $17,000 | $8,700 / $17,400 |
| HDHP minimum deductible | $1,700 / $3,400 | $1,750 / $3,500 |
| HSA contribution limit (age 55+ adds $1,000) | $4,400 / $8,750 | $4,500 / $9,000 |
| Medicare Part D drugs, out-of-pocket cap | $2,100 | $2,400 |
| Medicare Part D, standard deductible | $615 | $700 |
| Medicare Advantage, in-network maximum | $9,250 | $9,850 |
| Medicare Advantage, in and out of network combined | n/a | $14,800 |
| Medigap Plan K / Plan L | n/a | $8,360 / $4,180 |
| Original Medicare (Parts A and B) | No limit | No limit |
ACA Plans: $12,000 in 2027
The ACA limit applies to Marketplace plans and to most job-based plans, including self-funded ones. Plans can set a lower limit, and many do. Grandfathered plans are the main exception.
- The 2027 limit rose about 13%, from $10,600 to $12,000, the biggest jump in years.
- Family plans have a built-in limit for each person. No one person on a family plan pays more than $12,000, even if the family limit is $24,000.
- It only covers in-network care for covered benefits. Out-of-network bills may not count.
What Counts Toward the Out-of-Pocket Maximum
| Counts | Does not count |
|---|---|
| Deductible | Monthly premiums |
| Copays | Out-of-network care (usually) |
| Coinsurance | Services the plan does not cover |
| Prescription costs for covered drugs | Balance bills above the allowed amount |
Example
Your plan has a $3,000 deductible, 20% coinsurance and the 2027 maximum of $12,000. A $100,000 in-network hospital stay would cost you $3,000 plus 20% of the other $97,000, or $22,400. The cap stops you at $12,000. Try your own numbers in our coinsurance calculator.
HSA-Eligible High Deductible Plans
To pair with a health savings account in 2027, a plan needs a deductible of at least $1,750 ($3,500 for a family) and an out-of-pocket maximum of no more than $8,700 ($17,400 for a family). You can put up to $4,500 into an HSA, or $9,000 for a family, plus $1,000 more if you are 55 or older.
Medicare in 2027
- Original Medicare has no out-of-pocket maximum. After the Part B deductible you pay 20% of most costs, with no yearly cap.
- Part D: covered drug costs stop at $2,400 in 2027. After that you pay $0 for covered drugs for the rest of the year. The deductible is $700.
- Medicare Advantage: plans can set an in-network limit of no more than $9,850, and $14,800 combined for plans that cover out-of-network care.
- Medigap Plans K and L have their own caps: $8,360 and $4,180 in 2027.
- Still to come: CMS usually announces the 2027 Part B premium and deductible and the Part A deductible in November. We will add them here.
Want to see what you will owe on a bill? Use our patient responsibility calculator or copay calculator.
Sources: CMS, Premium Adjustment Percentage, Maximum Annual Limitation on Cost Sharing and Required Contribution Percentage for the 2027 Benefit Year (January 29, 2026); IRS Rev. Proc. 2026-24 (2027 HSA and HDHP limits); CMS, CY 2027 Medicare Advantage and Part D Rate Announcement (April 6, 2026); KFF, Medicare open enrollment FAQs (2027 Medicare Advantage limits); CMS, Out-of-Pocket Limits for Medigap Plans K and L for 2027 (October 2026).
Frequently Asked Questions
Reviewed by Hassan Raza Awan, Founder — 4+ years of hands-on U.S. medical billing experience. General billing information — verify against current CMS guidance and your payer contracts.
See the math in how to calculate deductible and coinsurance.
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