Medicare Cost Cap Act of 2026

Yearly Medicare cost cap for beneficiaries

This bill would create a yearly out-of-pocket limit for traditional Medicare (Parts A and B) beneficiaries. In 2028 the limit would be $5,000. After 2028 the Secretary would raise the limit each year by the annual percent change in average per-person Parts A and B spending (12-month period ending each July), rounded to the nearest $5. The limit would count deductibles, copays, coinsurance, and similar Part A/B cost-sharing, but would not count items Medicare does not cover or some extra charges when a doctor does not accept assignment. Once an individual reached the limit in a calendar year, they would not owe additional Part A or Part B cost-sharing for covered services that year; Medicare payments and provider billing would be adjusted so coinsurance and deductibles no longer apply after the limit is met. CMS would track accumulated costs and notify beneficiaries and providers, and the Secretary must announce the next year's limit by the first Monday in April beginning 2027.