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A comparison of the Maximum Out-Of-Pocket Limit (MOOP) for 2015 Medicare Advantage plans as compared to 2014 Medicare Advantage plans

Category: Out of Pocket: TrOOP and MOOP
Published on 2014-10-04 15:52:54


The Maximum Out-of-Pocket (MOOP) Limit for a Medicare Advantage plan caps how much you will spend on co-payments and co-insurance for covered or eligible Medicare Part A (hospitalization) and Part B (out-patient) medical services (and may include additional or supplemental benefits). Your Maximum Out-of-Pocket for Medicare Part D expenses is separate -- this is known as TrOOP or Total Out-of-Pocket costs.

Each Medicare Advantage plan sets its plan's MOOP.  The maximum out-of-pocket limit can range from $0 to $6,700.  Typically, Medicare Advantage plans with a MOOP of $0 are Special Needs Plans (SNPs).  The table below illustrates the most frequently occurring MOOP limits across all types of Medicare Advantage plans.

Top 2015 MOOP Limits for Medicare Advantage Plans
MOOP
Limit
Nbr of
2015
MA Plans
Nbr of
2014
MA Plans
Change in
Nbr of
Plans
Percent
Change
 $6,700 938 495 443 89%
$3,400 565 515 50 10%
$5,000 106 86 20 23%
$5,900 104 89 15 17%
$0 90 200 -110 -55%
$4,500 66 69 -3 -4%
$3,000 64 44 20 45%
$4,900 60 80 -20 -25%
$4,400 49 17 32 188%
$2,500 39 32 7 22%

Medicare Advantage plans may set their MOOP as any amount within the ranges shown in the CMS table below. This table shows that MOOP limits may be lower than the CMS-established maximum amounts and what MOOP amounts qualify as mandatory and voluntary MOOP limits.


2015 Voluntary and Mandatory MOOP Range Amounts By Plan Type
Plan Type Voluntary Mandatory
HMO $0 - $3,400 $3,401 - $6,700
HMO POS $0 - $3,400 In-network $3,401 - $6,700 In-network
Local PPO $0 - $3,400 In-network and
 $0 - $5,100 Combined
$3,401 - $6,700 In-network and
$3,401 - $10,000 Combined
Regional PPO $0 - $3,400 In-network
 and
$0 - $5,100 Combined
$3,401 - $6,700 In-network and
$3,401 - $10,000 Combined
PFFS (full network) $0 - $3,400 Combined $3,401 - $6,700 Combined
PFFS (partial network) $0 - $3,400 Combined $3,401 - $6,700 Combined
PFFS (non-network) $0 - $3,400 $3,401 - $6,700

As can be seen in the table above, out-of-network cost-sharing expenses may fall into a higher MOOP (for example, see Regional PPO above with a higher "combined" MOOP limit) or your out-of-network cost-sharing may not count toward your MOOP limit, as with the HMO POS plan type.








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