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How are MOOP and TrOOP related? Does your TrOOP go towards meeting your MOOP?

Category: Out-of-Pocket: TrOOP, RxMOOP, and MOOP
Updated: Apr, 20 2024

No.  TrOOP and MOOP 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 Medicare Advantage 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 2023 is $7,400 and $8,000 for 2024). 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 2024, MOOP is limited to $8,850. You can see how MOOP varies between 2021/2022/2023/2024 Medicare Advantage plans here: Q1News.com/1021.

We also have a section of FAQs on the TrOOP / MOOP topic:

Also see FAQ:
What is the Medicare Part D RxMOOP?

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