Grand Junction · 2027 plan year
Medicare Advantage Out-of-Pocket Maximum for 2027: $9,850
The most a Medicare Advantage plan may make you pay for in-network hospital and medical care in 2027 is $9,850, $600 more than this year. That number is a federal ceiling. Your plan picks its own figure underneath it, and in Mesa County more than half the plans that are coming back picked a higher one.
The bottom line
- $9,850 in-network is the 2027 ceiling, up from $9,250. A PPO's combined in- and out-of-network limit can go as high as $14,800, up from $13,900.
- Mesa County's 10 plans with drug coverage run from $4,900 to $9,850. One plan sits at the ceiling. None is at or under $4,450, the line CMS calls the lower limit.
- 5 of the 8 returning plans raised their limit; 3 held it; none lowered it. About 51% of the 8,687 people in those eight plans are in one that went up.
- The limit leaves out premiums and prescriptions. Part D has its own $2,400 threshold for 2027.
- Your new number is on the first pages of your Annual Notice of Change. You can act on it from October 15 through December 7.
The out-of-pocket maximum is the one number on a Medicare Advantage plan that only matters in a bad year. Most years you never get near it. The year you have a surgery, a cancer diagnosis or a long rehab stay, it is the number that decides what the year costs. So when it moves, it is worth five minutes, even if your premium is still $0.
Mesa County had 41,709 people on Medicare in June 2026 and 17,134 of them in a Medicare Advantage plan, per the CMS monthly enrollment file. About 26.6% of adults in the county live with high blood pressure (CDC PLACES), and it is the people managing a condition like that who are most likely to see the limit in action. Here is what the federal rule says for 2027, and then what each Grand Junction plan did with it.
The three federal limits for 2027
CMS does not set one limit. Under 42 CFR § 422.100(f)(4) it calculates three each year from Original Medicare spending data, rounds each to the nearest $50, and publishes them in a spring memo to the plans. The 2027 memo is dated April 22, 2026. Its Table 3:
| Tier | In-network limit (all plan types) | Combined in- and out-of-network (PPOs) |
|---|---|---|
| Lower | $0 to $4,450 | $0 to $6,700 |
| Intermediate | $4,451 to $7,150 | $4,451 to $10,750 |
| Mandatory | $7,151 to $9,850 | $7,151 to $14,800 |
Source: CMS, Final CY 2027 Standards for Part C Benefits, Bid Review and Evaluation, Table 3. The 2026 ceilings ($9,250 in-network, $13,900 combined) are from KFF's May 2026 analysis.
"Mandatory" is the confusing word. It does not mean plans must charge it. The memo defines it as the "highest in-network MOOP amount allowed by CMS." A plan may set its limit anywhere from $0 up to that figure, and the tier it lands in decides how much it is allowed to charge for individual services, which is the next table.
The increase itself is ordinary. The rule ties the limits to projected Original Medicare costs and caps any one-year jump at 10 percent; the memo notes the 2027 figures came in under that cap. $9,250 to $9,850 is about 6.5 percent.
What each Mesa County plan set for 2027
From the two CMS landscape files, matched by plan number. Members are September 2026 enrollment in Mesa County.
| Plan (2027) | 2026 limit | 2027 limit | Change | CMS tier | Members |
|---|---|---|---|---|---|
| Select Health Medicare Essential (HMO) Select Health · H1994-029 · $0 premium | $4,900 | $4,900 | same | Intermediate | 570 |
| HumanaChoice H5216-223 (PPO) Humana · H5216-223 · $20 premium | $4,900 | $4,900 | same | Intermediate | 1,060 |
| Aetna Medicare Signature (HMO) Aetna Medicare · H5593-007 · $0 premium | new | $5,900 | — | Intermediate | — |
| Humana Value Choice (PPO) Humana · H5216-078 · $0 premium | $5,000 | $6,250 | +$1,250 | Intermediate | 2,719 |
| HealthSpring Preferred (HMO) HealthSpring · H2752-007 · $0 premium | new | $7,150 | — | Intermediate | — |
| Aetna Medicare Signature (PPO) Aetna Medicare · H5521-207 · $0 premium | $6,750 | $7,150 | +$400 | Intermediate | 1,338 |
| Aetna Medicare Value Care (PPO) Aetna Medicare · H5521-443 · $18.40 premium | $5,500 | $7,150 | +$1,650 | Intermediate | 227 |
| Humana Essentials Plus Giveback (PPO) Humana · H5216-435 · $0 premium | $7,850 | $7,850 | same | Mandatory | 2,622 |
| HealthSpring True Choice (PPO) HealthSpring · H7849-147 · $0 premium | $6,800 | $9,500 | +$2,700 | Mandatory | 25 |
| Anthem Medicare Advantage (HMO-POS) Anthem Blue Cross and Blue Shield · H4346-012 · $0 premium | $9,250 | $9,850 | +$600 | Mandatory | 126 |
Sources: CMS CY2027 and CY2026 landscape files, Mesa County general plans with drug coverage, "In-Network Maximum Out-of-Pocket (MOOP) Amount"; CMS CPSC enrollment, September 2026. Tier is our reading of each amount against Table 3. Listing a plan is not a recommendation.
Three things I take from that table.
- The county's largest plan moved. Humana Value Choice, with 2,719 local members, went from $5,000 to $6,250. The premium is still $0, so nothing on the bill tells you.
- The biggest jump is $2,700. HealthSpring True Choice went from $6,800 to $9,500, close to the ceiling. Few people are in it locally, but if you are one of them, read your notice.
- Holding steady was possible. Three plans kept their limit, including both plans at the county floor of $4,900.
Eight other 2026 plans are not in the 2027 file for Mesa County at all. Those are a different situation with different rights, covered in the full 2027 Grand Junction plan list and in what to do when your plan is discontinued.
Why a higher limit can come with lower copays
This is the part most comparisons skip. CMS lets a plan charge more per service if it sets a lower yearly limit, and less per service if it sets a higher one. The memo says a plan may adopt the lower limit "in exchange for increased flexibility in cost-sharing requirements." Table 4 of the same memo lists the most a plan may charge in network, by tier:
| Service | Lower tier | Intermediate tier | Mandatory tier |
|---|---|---|---|
| Inpatient hospital stay, 6 days (total) | $3,062 | $2,756 | $2,450 |
| Inpatient hospital stay, 10 days (total) | $3,397 | $3,058 | $2,718 |
| Emergency room visit | $150 | $130 | $115 |
| Skilled nursing facility, days 1–20 (per day) | $20 | $10 | $0 |
| Skilled nursing facility, days 21–100 (per day) | $221 | $221 | $221 |
| Primary care visit | 50% or $70 | 40% or $55 | 30% or $40 |
| Specialist visit | 50% or $95 | 40% or $75 | 30% or $60 |
Source: CMS CY 2027 memo, Table 4, selected rows. These are the maximums CMS will approve, not what any plan charges. A plan's actual copays are in its Summary of Benefits and Evidence of Coverage, and many are well below these figures.
So the limit and the copays are two halves of one design. A plan in the mandatory tier can never charge more than $2,450 for a six-day hospital stay; an intermediate-tier plan can charge up to $2,756. That does not make a $9,850 limit a bargain. It means you cannot judge a plan on the limit alone, and you cannot judge it on the copays alone either.
What counts toward the limit, and what does not
- Counts: copays, coinsurance and deductibles for covered Part A and Part B services. The rule calls these "basic benefits."
- Does not count: your plan premium, your Part B premium, and Part D prescriptions. Drugs have their own threshold, $2,400 in 2027, and a deductible of up to $700 (CMS 2027 Announcement).
- Out-of-network care on a PPO counts toward the combined limit, which is higher and is not in the CMS landscape file. 6 of Mesa County's 10 plans are PPOs. Look for the combined figure in the Evidence of Coverage.
- Extras such as dental, vision and hearing are plan-specific. Check the Evidence of Coverage before assuming a dental bill counts.
When you reach the limit, Medicare.gov says, "you'll pay nothing for covered services for the rest of the year." The plan has to keep the tally. The rule makes it "responsible for tracking out-of-pocket spending" and requires it to "alert enrollees and contracted providers" when the in-network limit is reached. The count starts over each January 1.
Not sure what your plan's limit is for 2027, or what it would take to reach it?
Brian Penner has worked with Medicare clients for more than 22 years and is licensed in Colorado and Utah. Bring your Annual Notice of Change, your doctors and your prescriptions. We will find the new limit, price a realistic bad year against the plans we offer in Mesa County, and leave the decision with you. In person at our Grand Junction office or by phone anywhere on the Western Slope. No cost, no pressure. We do not offer every plan available in your area.
Book a 2027 plan review →Original Medicare has no limit at all
It is worth saying plainly, because the comparison runs both ways. Medicare.gov: "There's no yearly limit on what you pay out-of-pocket, unless you have supplemental coverage." For most people that supplemental coverage is a Medigap policy. Plan G pays Medicare's cost sharing after the Part B deductible ($283 in 2026), so there is nothing left to cap. Plans K and L work more like a capped plan, with limits of $8,000 and $4,000 in 2026 on the Medicare.gov benefit chart.
The catch in Colorado is getting in. Outside your first six months on Part B or a guaranteed-issue event, a Medigap company can ask health questions. A limit going up is not a guaranteed-issue event. A plan being discontinued is, which is why the Medigap post for people whose plan ended reads differently from this one.
How to use this before December 7
- Find the line in your Annual Notice of Change. It is in the cost summary near the front, labeled maximum out-of-pocket amount, with this year and next year side by side. How to read the rest of that letter.
- Ask whether you have ever come close. If your worst year in the last five cost you $1,500 in copays, a limit moving from $5,000 to $6,250 changes your risk, not your budget.
- If you are managing something serious, price the bad year. Limit, plus twelve months of premium, plus the drug deductible. Do it for your plan and for two others.
- Check doctors and prescriptions before the limit. A low limit at a hospital you cannot use is not protection. Networks and formularies each have their own post.
- Decide by December 7. A change made during the Annual Enrollment Period starts January 1.
How we know all this: the Medicare On Main Data Desk frames every article with public data — here, the CMS memo that sets the 2027 Part C out-of-pocket and cost-sharing limits, the federal rule behind it, the CMS CY2026 and CY2027 landscape files for Mesa County matched by Contract ID and Plan ID, the CMS September 2026 county enrollment file, KFF's analysis of the 2026 limits, and Medicare.gov. Mentioning a carrier is factual reporting, not endorsement or criticism; showing a plan's limit is not a recommendation. This is education, not advice; confirm plans, costs and eligibility with a licensed agent or Medicare.gov. We take no payment from any carrier to feature a plan.
Frequently asked questions
What is the maximum out-of-pocket for Medicare Advantage in 2027?
$9,850 for in-network care. That is the highest in-network limit CMS allows any Medicare Advantage plan to set for 2027, per Table 3 of the agency's April 22, 2026 bid memo, up from $9,250 in 2026. A PPO may also set a combined in-network and out-of-network limit as high as $14,800. Those are ceilings, not what most plans charge: in Mesa County the ten 2027 plans with drug coverage run from $4,900 to $9,850.
Is the Medicare Advantage out-of-pocket maximum going up in 2027?
The federal ceiling is, by $600 (from $9,250 to $9,850 in-network, and from $13,900 to $14,800 combined for PPOs). Whether your own plan's limit goes up is a separate question answered in your Annual Notice of Change. In Mesa County, five of the eight returning plans raised their in-network limit for 2027 and three kept it the same; none lowered it.
Does the out-of-pocket maximum include prescription drugs?
No. The federal rule sets the limit for "basic benefits," meaning Part A and Part B services. Part D prescriptions have their own yearly out-of-pocket threshold, $2,400 in 2027, and a drug deductible of up to $700. A bad year can reach both limits.
Does the out-of-pocket maximum include my monthly premium?
No. The plan premium and the Part B premium are paid on top of it. The limit counts the copays, coinsurance and deductibles you pay for covered Part A and Part B services.
What happens when I reach my Medicare Advantage out-of-pocket maximum?
Medicare.gov puts it this way: "Once you reach your plan's limit, you'll pay nothing for covered services for the rest of the year." The federal rule also requires the plan to track your spending and to alert you and your in-network providers when the limit is reached. The count starts over on January 1.
Does Original Medicare have an out-of-pocket maximum?
No. Medicare.gov says of Original Medicare, "There's no yearly limit on what you pay out-of-pocket, unless you have supplemental coverage." A Medigap policy is the usual supplemental coverage. Two Medigap plans carry their own limits (Plan K $8,000 and Plan L $4,000 in 2026); Plan G has none because it pays Medicare's cost sharing after the Part B deductible.
Sources
- CMS — Final Contract Year 2027 Standards for Part C Benefits, Bid Review and Evaluation (HPMS memo, April 22, 2026), Tables 3 and 4.
- CMS — Medicare Advantage Rates & Statistics (the MOOP and cost-sharing calculation files the memo points to).
- 42 CFR § 422.100(f)(4) and (f)(5) — in-network and combined maximum out-of-pocket limits.
- CMS — CY2027 Medicare Advantage and Part D Landscape file (September 2026 release) — the 10 Mesa County rows.
- CMS — CY2026 Medicare Advantage and Part D Landscape file (September 2026 release) — each returning plan's 2026 limit.
- CMS — Monthly Enrollment by Contract/Plan/State/County (CPSC), September 2026.
- KFF — Medicare Advantage Out-of-Pocket Limits: Variation and Trends (May 28, 2026; the 2026 limits and averages).
- Medicare.gov — Compare Original Medicare & Medicare Advantage (yearly limit on what you pay).
- CMS — 2027 Announcement of Medicare Advantage and Part D rates and policies (Part D deductible $700, out-of-pocket threshold $2,400).
- Medicare.gov — Compare Medigap plan benefits (Plan K $8,000 / Plan L $4,000 limits, 2026).
- CMS Medicare Monthly Enrollment (data.cms.gov) — Mesa County, CO, June 2026.
- CDC PLACES, 2023 — via the Medicare On Main Data Desk — Mesa County high blood pressure prevalence.
- Medicare Plan Compare (Medicare.gov) — every plan in your county, with the copays the landscape file does not carry.
