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Medicare Advantage 2027 Out-of-Pocket Limit Is $9,850 In-Network, $14,800 With PPO Out-of-Network Care

Medicare Open Enrollment for 2027 coverage opened on October 15, 2026, and closes on December 7, 2026, the window the Centers for Medicare & Medicaid Services (CMS) announced on September 28, 2026, alongside a projection that the weighted average Medicare Advantage premium will fall from $14.37 a month in 2026 to $12.00 in 2027. The premium is the small number; the large one is the plan's maximum out-of-pocket amount, or MOOP, and CMS has capped it for 2027 at $9,850 for in-network care and $14,800 for in-network and out-of-network care combined. A plan with drug coverage adds a separate Part D limit of $2,400, so the $9,850 figure now circulating as the 2027 Medicare Advantage limit is one of three ceilings, and for a PPO member who sees out-of-network doctors it is not the one that ends the year's spending. Both MOOP figures are maximums, not the amount on a given plan. Plans pick a number at or below them in one of three tiers, set by a CMS memo dated April 22, 2026, u...

RAP Undercuts the IBR Monthly Payment in Three Income Bands, Not in Four

Two federal repayment formulas can apply to the same Direct Loan balance in 2026, and they are not built from the same input. The Repayment Assistance Plan (RAP) reads adjusted gross income straight off the return and applies a bracket rate to the whole of it. Income-Based Repayment subtracts 150 percent of the federal poverty guideline first and applies its rate only to what is left. Because one formula starts at the first dollar of income and the other starts after a subtraction, the plan that produces the smaller monthly payment is not the same plan at every income.

Worked against the 2026 poverty guideline for a one-person household, the cheaper of the two changes hands six times between $10,000 and $110,000 of adjusted gross income. The Repayment Assistance Plan is the lower payment in three income bands and the higher payment in four. Three of the six switches happen where the two schedules genuinely cross. The other three happen because the Repayment Assistance Plan brackets step, and one dollar of additional income moves the borrower onto the next rate.

Who Still Has a Choice

Every income-driven plan now sits in one section, 34 CFR 685.209, and its paragraph (d)(5) states that "only Direct Loans made before July 1, 2026, may be repaid under the PAYE, IBR, and ICR plans." A loan first made on or after that date has the Repayment Assistance Plan and the fixed plans open to it, and not IBR.

Paragraph (c)(6) reads: "Any Direct Loan borrower may repay under the Repayment Assistance Plan if the borrower has loans eligible for repayment under the plan." Paragraph (d)(2) for IBR and paragraph (d)(4) for the Repayment Assistance Plan use identical wording: "Direct Subsidized Loans, Direct Unsubsidized Loans, Direct PLUS Loans made to graduate or professional students, and Direct Consolidation Loans that are not excepted consolidation loans."

The regulation defines a new borrower under IBR as "An individual who has no outstanding balance on a Direct Loan or FFEL program loan before July 1, 2014, and obtains no new loan on or after July 1, 2026, or who has no outstanding balance on such a loan on the date the borrower obtains a loan after July 1, 2014, but before July 1, 2026." A borrower who meets that description pays 10 percent of discretionary income. One who does not pays 15 percent. Every figure below uses the 10 percent version.

Two gates, and only the second one is about income When was the Direct Loan made? 34 CFR 685.209(d)(5) Made before July 1, 2026 Both plans are open Repayment Assistance Plan or IBR Made on or after July 1, 2026 IBR is closed Repayment Assistance Plan only Inside IBR only: is the borrower a new borrower as (b) defines it? Meets the definition 10 percent Does not meet it 15 percent of discretionary income, divided by 12 The definition turns on July 1, 2014 and July 1, 2026. The Repayment Assistance Plan rate does not ask either question. It reads adjusted gross income against eleven brackets and takes $120 or 1 to 10 percent of it. Both plans exclude Parent PLUS loans and excepted consolidation loans. Source: 34 CFR 685.209(b), (d) and (f).

Two Formulas Built From Different Inputs

Paragraph (b) first sets a base payment as an annual figure keyed to eleven adjusted gross income brackets. The first clause reads "Not more than $10,000, is $120," and the rate then rises by one percentage point for each $10,000 step. The eighth clause reads "More than $70,000 and not more than $80,000, is 7 percent of such adjusted gross income," and the eleventh and last clause stops at "More than $100,000, is 10 percent of such adjusted gross income." The boundaries are written as "not more than" and "more than," so $30,000 falls inside the 2 percent bracket while $30,001 falls inside the 3 percent bracket.

Paragraph (f)(5) then converts the annual figure into a monthly one. It has two clauses and no others: the payment equals "the borrower's applicable base payment, divided by 12" minus "$50 for each dependent of the borrower." Paragraph (g)(3) supplies the floor for a payment computed under (f)(5): where that amount falls below ten dollars, "the monthly payment is $10 except that the final payment may be less than $10." IBR's floor sits in a different clause, (g)(1)(iii), which sets the monthly payment at $0 where the computed amount is "Less than $5" and at $10 where it is "Equal to or greater than $5 but less than $10." Neither clause of (f)(5) is a ceiling.

Discretionary income is defined as "the greater of $0 or the difference between the borrower's income as determined under paragraph (e)(1) of this section and" a percentage of the poverty guideline that the same definition then sets separately for each plan: 225 percent for REPAYE, 150 percent for IBR and PAYE, and 100 percent for ICR. Paragraph (f)(2) supplies the rest, and it is where the ceiling appears: "the borrower's monthly payments are the lesser of—(i) 10 percent of the borrower's discretionary income, divided by 12; or (ii) What the borrower would have paid on a 10-year standard repayment plan." Income is defined for both plans as adjusted gross income as reported to the Internal Revenue Service, or an approved alternative documentation of taxable income.

The definition of the poverty guideline points outside the Department of Education, to "the income categorized by State and family size in the Federal poverty guidelines published annually by the United States Department of Health and Human Services." The 2026 update, published in the Federal Register on January 15, 2026 and effective January 13, 2026, sets the guideline for a one-person household in the 48 contiguous states and the District of Columbia at $15,960, with $5,680 added for each additional person. Alaska and Hawaii have separate, higher tables. One hundred fifty percent of $15,960 is $23,940, and that is the amount IBR removes before it takes its 10 percent.

The Same Income, Priced Two Ways

The figures below describe a borrower who files a single return, claims no dependents, and is a household of one, using the 2026 guideline for the 48 contiguous states. At an adjusted gross income of $20,000 the Repayment Assistance Plan takes 1 percent, or $200 a year. IBR takes nothing, because $20,000 sits below $23,940 and discretionary income is zero.

By $30,000 the order has already reversed. The Repayment Assistance Plan takes 2 percent, or $600 a year, which is $50.00 a month. IBR takes 10 percent of $6,060, or $606 a year, which is $50.50 a month. Add one dollar of income and the bracket steps: at $30,001 the base payment becomes 3 percent, or $900.03 a year, while IBR moves only to $606.10. One dollar of adjusted gross income has raised the Repayment Assistance Plan figure by $300.03 for the year and put IBR back in front.

The same event repeats twice, and the step grows each time. At $70,000 the Repayment Assistance Plan charges 6 percent, or $4,200, against IBR's $4,606. At $70,001 the rate becomes 7 percent and the base payment becomes $4,900.07, a rise of $700.07 for one dollar of income. At $80,000 the two are six dollars apart, $5,600 against $5,606. At $80,001 the Repayment Assistance Plan becomes $6,400.08 against IBR's $5,606.10, a gap of $793.98, and IBR remains the lower of the two from there upward.

The two payment schedules cross three times Monthly payment, one-person household, no dependents, 2026 $0 $200 $400 $600 $800 $20,000 $40,000 $60,000 $80,000 $100,000 $29,925 $34,200 $79,800 Repayment Assistance Plan IBR, new borrower, 10 percent Adjusted gross income Computed from the payment rules at 34 CFR 685.209(b), (f) and (g), using the 2026 poverty guideline of $15,960 published by the Department of Health and Human Services on January 15, 2026.

Above $100,000 the two schedules run parallel. Both take 10 percent of income, so the only thing left between them is the subtraction IBR made at the start. The Repayment Assistance Plan figure exceeds the IBR figure by 10 percent of $23,940, which is $2,394 a year, or $199.50 a month, and that difference holds at $110,000 and at every income inside the top bracket.

Six Places the Order Changes Hands

Setting the two annual formulas equal produces a crossing income for each bracket. The bracket rate times income equals 10 percent of income minus $2,394, so the crossing sits at $2,394 divided by the difference between 10 percent and the bracket rate. Most of those crossings fall outside the bracket that produced them, which is why the answer does not resolve into a single switch. Three of them land inside their own bracket.

  • $29,925, inside the 2 percent bracket. Both formulas produce $598.50 for the year. Below it IBR is lower; above it the Repayment Assistance Plan is lower.
  • $34,200, inside the 3 percent bracket. Both produce $1,026.00 a year, or $85.50 a month.
  • $79,800, inside the 7 percent bracket. Both produce $5,586.00 a year, or $465.50 a month.

The remaining three switches are bracket edges rather than crossings: $30,000 to $30,001, $70,000 to $70,001, and $80,000 to $80,001. Counting both kinds, the Repayment Assistance Plan is the lower monthly payment in three bands — $29,925 to $30,000, $34,200 to $70,000, and $79,800 to $80,000 — and the higher payment in the four bands that lie below, between and above them. The other two bands are 75 and 200 dollars wide.

At $40,001 the annual figures are $1,600.04 and $1,606.10. At $60,001 they are $3,600.06 and $3,606.10. In both cases the year's difference is about six dollars, which is roughly fifty cents a month on a payment of several hundred.

What Happens to the Balance Is a Separate Question

Paragraph (h)(4)(i) provides that "Under the Repayment Assistance Plan, during all periods of repayment on all loans being repaid under the Repayment Assistance Plan, the Secretary does not charge the borrower's account for any accrued interest that is not covered by the borrower's on-time payment of the amount due for that month." The next clause, (h)(4)(ii), qualifies it: where a payment is credited to a future month and equals or exceeds the on-time monthly amount, the accrued interest is charged after all. The waiver is tied to paying on time in the month itself.

IBR's interest treatment is narrower on its face. Paragraph (h)(2)(i) provides that "the Secretary does not charge the borrower's account with an amount equal to the amount of accrued interest on the borrower's Direct Subsidized Loans and Direct Subsidized Consolidation Loans that is not covered by the borrower's payment for the first three consecutive years of repayment under the plan, except as provided for the IBR and PAYE plans in paragraph (h)(2)(ii) of this section." Unsubsidized balances are outside it. The next clause says what counts toward the three years: "Under the IBR and PAYE plans, the 3-year period described in paragraph (h)(2)(i) of this section excludes any period during which the borrower receives an economic hardship deferment under § 685.204(g); and".

The Repayment Assistance Plan also carries a principal provision that has no counterpart in IBR. Under paragraph (o)(2), when the borrower is not in deferment or forbearance and an on-time payment reduces principal by less than $50, "The Secretary reduces such total outstanding principal of the borrower by an amount that is equal to the lesser of $50 or the monthly payment made, minus the amount applied to principal." Clause (o)(2)(ii) withholds that reduction where a payment is credited forward in the same way (h)(4)(ii) describes.

Paragraph (k)(7) provides that a Repayment Assistance Plan borrower "receives forgiveness of the remaining balance of the borrower's loans after the borrower has satisfied 360 monthly payments or the equivalent in accordance with paragraph (k)(8) of this section over a period of at least 30 years." Paragraph (k)(2) sets 240 payments over at least 20 years for a new borrower under IBR, and (k)(1) sets 300 payments over at least 25 years for one who is not. Paragraph (k)(8) then defines separately which payments count toward the 360, including on-time payments under the plan itself and months spent in an unemployment or economic hardship deferment.

The monthly number is not the whole comparison What happens to the part of the balance the payment does not cover Repayment Assistance Plan Unpaid accrued interest Not charged, if the payment is on time 34 CFR 685.209(h)(4) Principal match Up to $50 a month added to principal 34 CFR 685.209(o)(2) Forgiveness 360 payments, at least 30 years Qualifying payments are defined separately in (k)(8) IBR Unpaid accrued interest Subsidized loans only, for a three-year period that excludes hardship deferment Principal match No comparable provision Forgiveness 240 payments if a new borrower 300 payments if not at least 20 or 25 years A lower monthly payment and a lower total paid are different questions, and the gap between 360 payments and 240 or 300 is where the two clocks separate.

Where This Doesn't Apply

Household size moves every crossing. The 2026 guideline is $21,640 for two people and $33,000 for four, so the subtraction IBR makes grows with family size while the Repayment Assistance Plan brackets do not move at all. Dependents work the other way, because (f)(5)(ii) removes $50 a month, or $600 a year, for each one. For a single parent with one child at $60,000, the Repayment Assistance Plan figure is $200.00 a month against IBR's $229.50; at $75,000 the same household sees $387.50 against $354.50. The order flips in a different place than it does for a household of one.

The 10-year standard ceiling is left out above. Paragraph (f)(2)(ii) caps an IBR payment at what the borrower would have paid on a 10-year standard plan, a ceiling that depends on the balance and the interest rates. A small balance can put IBR under its ceiling long before the crossings described here. The Repayment Assistance Plan has no equivalent clause.

The 15 percent rate changes the answer. A borrower who is not a new borrower under IBR pays 15 percent of discretionary income. At $60,000 for a household of one that is $5,409 a year, or $450.75 a month, against the Repayment Assistance Plan's $250.00. None of the three crossings above survives at that rate.

Marital status and filing status change the inputs. Paragraph (e)(1), headed "Income," opens "For purposes of calculating the borrower's monthly payment amount under the Repayment Assistance Plan, REPAYE, IBR, and PAYE plans" and so covers both plans compared here. It provides that "For a married borrower filing a joint Federal income tax return, except as provided in paragraph (e)(1)(i)(A) of this section, the combined income of the borrower and spouse is used in the calculation." Clause (e)(1)(i)(A) is that exception: "For an unmarried borrower, a married borrower filing a separate Federal income tax return, or a married borrower filing a joint Federal tax return who certifies that the borrower is currently separated from the borrower's spouse or is currently unable to reasonably access the spouse's income, only the borrower's income is used in the calculation." The figures above use a borrower filing a single return.

Public Service Loan Forgiveness is not addressed here. This comparison covers two payment formulas and the balance provisions attached to them, not how payments under either plan count toward the separate program in § 685.219.

Numbers to Re-check

FigureBasis used hereWhere to verifyWhen it changes
Poverty guideline, one person, 48 states: $15,9602026Department of Health and Human Services, Federal RegisterPublished each January
IBR discretionary income line: $23,9402026, household of one34 CFR 685.209(b), applied to the guideline aboveWith the guideline
Repayment Assistance Plan brackets: $120, then 1 to 10 percentCurrent regulation34 CFR 685.209(b)By statute or rulemaking; the brackets are not indexed on their face
Loan-date cutoff for IBR: July 1, 2026Current regulation34 CFR 685.209(d)(5)By rulemaking
Forgiveness counts: 360, 240, 300 paymentsCurrent regulation34 CFR 685.209(k)By rulemaking

The statutory ground for the plan sits in 20 U.S.C. 1087e; the operating detail quoted above is in the Department of Education regulation.

This article explains how the rules are written. It is not tax, legal, or insurance advice, and it does not account for any individual situation. Amounts and thresholds change; verify the current figures at the source listed above before acting.

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