Medicare Cost Cap Act of 2026

Key Points

• Starting in 2028, traditional Medicare beneficiaries would have a hard cap of $5,000 a year on out-of-pocket costs like deductibles, copays, and coinsurance for Part A and B services.
• Once a beneficiary hits the cap, Medicare pays 100 percent of covered costs for the rest of that year, and providers cannot bill the patient extra for those services.
• The cap rises every year based on the growth in average Medicare spending per person, and HHS must publicly announce the new limit each April starting in 2027.
• The bill eliminates the asset test for the Medicare Savings Program and Low-Income Subsidy starting in 2028, so savings or property ownership can no longer disqualify seniors from these cost-sharing assistance programs.
• Income eligibility limits for these low-income assistance programs would rise to 200 percent of the federal poverty line, expanding help to more middle-income Medicare beneficiaries.
• The government must track each beneficiary's spending and automatically notify both the patient and their providers once the annual cap has been reached.