are two different measures of out-of-pocket (OOP) costs - and TrOOP and MOOP are not
related, aside from both defining OOP costs - and your TrOOP does not count toward your MOOP.
TrOOP (Total out-of-pocket costs)
is the out of pocket spending limit
for Medicare Part D prescription drug coverage (provided by both
plans that includes prescription drug coverage (MAPDs) and stand-alone
Medicare Part D plans (PDPs)).
TrOOP defines the exit point
of the Donut Hole or Coverage Gap phase. Once you spend beyond your
TrOOP limit, you enter the Catastrophic Coverage portion
of your Medicare Part
D plan and pay around 5% of retail for your prescriptions for the
remainder of the year.
Each year, the Centers for Medicare and Medicaid
Services (CMS) establishes the annual TrOOP limit (TrOOP for 2021 is
$6,550 and $7,050 for 2022). You can see how TrOOP limits have changed over the years here:
MOOP (Maximum out-of-pocket costs)
is a Medicare Advantage plan's OOP
spending limit for Medicare Part A and Medicare Part B coverage. When
you reach your MOOP
, you should not have more Medicare Part A and
Medicare Part B expenses for the remainder of the year.
Look for language in your Medicare Advantage Summary of Benefits that might read something like: "Your yearly limit(s) in this plan: $6,700 for services you receive from in-network providers. If you reach the limit on out-of-pocket costs [MOOP], you keep getting covered hospital and medical services and we will pay the full cost for the rest of the year."
However, depending on
your Medicare Advantage plan, out-of-network coverage might be excluded
from your MOOP. Please look for language in your Medicare Advantage plans (MA or MAPD) Summary of Benefits that reads like: "Your yearly limit(s) in this plan: $4,000 for services you receive from in-network providers. If you reach the limit on out-of-pocket costs [MOOP], you keep getting covered hospital [Medicare Part A] and medical [Medicare Part B] services and we will pay the full cost for the rest of the year. Please note that you will still need to pay your monthly premiums and cost-sharing for your Part D prescription drugs."
Medicare Advantage plans can have varying MOOP limits
and each year CMS establishes a limit on MOOP. In 2021 and 2022, MOOP is limited to
$7,550. You can see how MOOP varies between 2020/2021/2022 Medicare Advantage
We also have a section of FAQs on the TrOOP / MOOP topic: