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Taking the guesswork out of your plan!

Understanding The MOOP

All Medicare Advantage plans have a Maximum Out-Of-Pocket limit or (MOOP). This refers to the maximum amount of money that a Medicare beneficiary can pay out-of-pocket each calendar year for eligible health-care services. Medicare Part D prescription drug costs do not count toward the MOOP.

This amount can vary between Medicare Advantage plans and is currently restricted to a maximum of $6,700.

It is important to note that most annual out-of-pocket spending limits apply only to in-network Medicare providers.

If a person chooses to receive services from a provider that is outside of the plan’s network, they could be subject to a higher out-of-network limit. Some companies have out-of-network limits as high as $10,000. The other possibility is that the plan does not have a cap on out-of-network expenses and does not count them toward the calendar year expenditures at all.

If Medicare beneficiary has a maximum out of pocket limit of $6700 they could owe as much as $13,400 out-of-pocket in as little as two months. This could happen if a person had a serious illness in December and continued treatment into the following calendar year. If that same person continued to receive medical care into the following year, it is possible that they could owe the MOOP three times in as little as fourteen months. That would create a financial exposure of $21,100

For married couples where both spouses have severe medical conditions these numbers could possibly double if both spouse experienced high medical expenses simultaneously.

In addition, these figures do not include any out-of-network expenses.

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