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2024 Medicare Advantage plan Maximum Out-Of-Pocket (MOOP) limits are changing and can reach $8,850 -- with 4.4 million members seeing a MOOP increase from $50 to $5,400.

Category: Annual Medicare Plan Changes
Published: Oct, 07 2023 02:10:55

Your Medicare Advantage plan's Maximum Out-of-Pocket (MOOP) threshold limits how much you will spend on healthcare copayments and coinsurance for eligible Medicare Part A (in-patient or hospitalization) and Medicare Part B (out-patient or doctor visit) services.  A higher MOOP limit means you will spend more out-of-pocket for your Medicare Part A and Medicare Part B covered services before reaching the annual maximum cost threshold.  Each year MOOP limits can change and, in 2024, Medicare Advantage plans can increase their Maximum Out-of-Pocket limit up to $8,850.

And this means:  If you have high healthcare expenses, you may want to watch out for an increase in your Medicare Advantage plan's out-of-pocket spending limit.  If you find that your MOOP is increasing, you may wish to search for another Medicare Advantage plan having a lower MOOP limit ($3,850 or less).  In short, the higher the MOOP limit, the higher your covered healthcare total expenses can be for the year.  However, on a positive note, your Part A and Part B expenses will not exceed $8,850 for in-network Medicare cost-sharing (remember, this does not include Part D prescription drug expenses).

Question:  How many people will see an increase in their in-network MOOP?

About 4.4 million Medicare Advantage plan members will see an increase in their in-network 2024 MOOP.  The MOOP increases for these people can range from $50 to $5,400 - and the following table shows the number of people affected by different ranges of 2024 MOOP increases.

2024 Medicare Advantage Plans In-Network MOOP Limit Increases

Range of MOOP Limit Increase Number of Members Affected
$5,000 to $5,400 489
$4,000 to $4,999 1,669
$3,000 to $3,999 18,263
$2,000 to $2,999 178,130
$1,000 to $1,999 889,493
$500 to $999 1,223,538
less than $500 2,106,581

For example, the members of the Wellcare No Premium (HMO) in California will see an increase of $4,350 in the in-network MOOP and members of the AARP Medicare Advantage Patriot (PPO) in North Carolina will see a MOOP increase of $3,300.

You can see each Medicare Advantage plan's MOOP using our 2024 Medicare Advantage Plan Finder (MA-Finder.com/2024) or you can browse through the states/counties via our 2024 Overview by State.  See annual 2024 Medicare Advantage plan changes such as premium, deductible, MOOP, and formulary size using our MA-Compare tool found at: MA-Compare.com/2024

In-network vs. Out-of-network MOOP

The MOOP limit is a cap on your out-of-pocket expenses and applies to in-network Medicare Part A and Medicare Part B eligible medical cost-sharing.  Please refer to your plan's documentation to see whether your out-of-network healthcare costs are included in your MOOP.  For example, you may find that local and regional PPO Medicare Advantage plans can have a combined maximum MOOP of up to $13,300 (for in-network and out-of-network coverage) and local HMOs may not include out-of-network healthcare costs in your annual MOOP limit. 

The range of in-network 2024 MOOP thresholds

The 2024 Medicare Advantage MOOPs range from $0 to $8,850 — and often, Medicare Advantage plans with a MOOP of $0 are Medicare Advantage PFFS plans, MSAs, or Cost plans.  In 2023, Medicare renamed the Voluntary MOOP to "Lower" MOOP and added a third category, "Intermediate" MOOP limit between the two MOOPs -- so the MOOP limits are: "Lower", "Intermediate", and "Mandatory" MOOP.

Question:  How are the Lower, Intermediate, and Mandatory MOOP limit set?

The Lower, Intermediate, and Mandatory MOOP limits are set by the Centers for Medicare and Medicaid Services (CMS).  Per CMS, the Mandatory MOOP amount represents approximately the 95th percentile of projected beneficiary out-of-pocket spending.  In other words, five percent of Original Medicare beneficiaries are expected to incur approximately $8,850 or more in Parts A and B deductibles, copayments, and coinsurance.  The Lower MOOP amount of $3,850 represents approximately the 85th percentile of projected Original Medicare out-of-pocket spending.  The Intermediate MOOP is set at the numeric midpoint of the Mandatory and Lower MOOP limits.

The following chart shows a comparison of the number of plans falling into the three established MOOP ranges.

Medicare Advantage Plans per CMS Defined MOOP Limits

2024 2023
MOOP Limit Range Nbr of Plans % of Plans MOOP Limit Range Nbr of Plans % of Plans
$0 to $3,850
1,288 29% Lower: $0 to $3,650 1,165 26%
$3,851 to $6,350
2,055 46% Intermediate:
$3,651 to $6,000
1,955 44%
$6,351 to $8,850
1,057 24% Mandatory:
$6,001 to $8,300
1,307 30%

The following chart highlights the most frequently used 2024 MOOP limits.

Analysis of how Maximum out of pocket limits have changed for Medicare Advantage plans

The 2024 MOOP dispersion:  Different out-of-pocket limits for different Medicare Advantage plans

We found that across all 2024 Medicare Advantage plans, only 683 plans increased their MOOP, 2,329 plans kept the same MOOP as last year, and 596 plans reduced the plan's MOOP limit.

When MOOP is evaluated across all Medicare Advantage plans (excluding MMPs and SNPs which do not have a MOOP), we see a slight increase in the average 2024 MOOP limit.  The 2024 average MOOP is around $5,064 as compared to $5,061 in 2023.

The table below illustrates some of the more frequently occurring 2024 MOOP limits across all types of Medicare Advantage plans.  Note that 70% of 2024 Medicare Advantage plans have a MOOP over the $3,850 "Lower" MOOP as compared to 74% over the 2023 "Lower" MOOP of $3,650.

Top 2024 MOOP Limits for Medicare Advantage Plans and
statutory Lower, Intermediate, and Mandatory MOOP limits

  Number of Medicare Advantage Plans
MOOP Limits 2024 2023 Change '23 to '24 Percent 2022 2021
$6,700 231 421 -190 -45% 520 572
$4,900 231 210 21 10% 207 220
$5,900 222 223 -1 0% 250 216
$4,500 205 206 -1 0% 203 164
$7,550 193 318 -125 -39% 513 575
$5,500 187 196 -9 -5% 186 153
$3,400 185 207 -22 -11% 267 267
$3,900 158 182 -24 -13% 163 117
$5,000 139 149 -10 -7% 134 121
$2,900 113 122 -9 -7% 96 41
$8,850 109 0
109 0% 0
$3,800 86 34 52 153% 33 21
$8,300 78 120 -42 -35% 0
2024 Lower, Intermediate, and Mandatory MOOP limits
$3,850 76 5 71 1,420% 4 1
$6,350 73 3 70 0% 0
$8,850 109 0
109 0% 0

The following chart shows how the MOOP range has changed from 2020 through 2024 (excluding $0 MOOP plans).

Analysis of how Maximum out of pocket limits have changed for Medicare Advantage plans

Medicare Advantage plans may set their MOOP threshold as any amount within the ranges shown in the CMS table below.  As an example, HMO plans can set their plan's MOOP as high as $8,850.  However, an HMO plan that sets MOOP within the Lower ($0 - $3,850) or Intermediate ($3,851 - $6,350) range is granted greater flexibility for individual service category cost-sharing. 

2024 Lower, Intermediate and Mandatory
MOOP Range by Type of Medicare Advantage plan
Plan Type Lower
Intermediate Mandatory
HMO $0 to $3,850 $3,851 to $6,350 $6,351 to $8,850
HMO POS $0 to $3,850 In-network $3,851 to $6,350 $6,351 to $8,850 In-network
Local PPO $0 to $3,850 In-network and
$0 to $5,750 Combined
$3,851 to $6,350 In-network and
$3,851 to $9,550 Combined
$6,351 to $8,850 In-network and
$6,351 to $13,300 Combined
Regional PPO $0 to $3,850 In-network and
$0 to $5,750 Combined
$3,851 to $6,350 In-network and
$3,851 to $9,550 Combined
$6,351 to $8,850 In-network and
$6,351 to $13,300 Combined
PFFS (full network) $0 to $3,850 $3,851 to $6,350 $6,351 to $8,850 Combined
PFFS (partial network) $0 to $3,850 $3,851 to $6,350 $6,351 to $8,850 Combined
PFFS (non-network) $0 to $3,850 $3,851 to $6,350 $6,351 to $8,850

Important: In-network MOOP and out-of-network MOOP

Again, 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 (IMPORTANT!) your out-of-network cost-sharing may not count toward your MOOP limit, as with the HMO POS plan type.  Please notice that the Lower, Intermediate, and Mandatory MOOP limits now change yearly and the 2024 limits are slightly higher than the 2023 figures. 

MOOP and Special Needs Plans (and MMPs)

As a reminder, you may notice that Medicare Advantage MMP (Medicare-Medicaid plans) and SNPs (Special Needs Plans), such as SNPs for dual Medicare/Medicaid eligible beneficiaries (D-SNPs), do not have a MOOP.

Reminder about Medicare Advantage MOOP and Part D drug plan TrOOP

Your Total Out-of-Pocket spending limit (TrOOP) for your Medicare Part D prescription drug coverage is not the same as your Medicare Part A and Medicare Part B Maximum Out-of-Pocket spending limit (MOOP).  For more information, please see our Frequently Asked Question: TrOOP is not MOOP.

Bottom Line:  One of the best features of a Medicare Advantage plan is that, unlike Original Medicare, your annual healthcare spending may be capped at a certain level.  Please review your 2024 Medicare Advantage plan's coverage information to learn more about your plan's MOOP.  You should be able to find your 2024 MOOP in your plan's 2024 Annual Notice of Change letter (ANOC).  You can also telephone your current Medicare Advantage plan using the toll-free Member Services number found on your Member ID card for more information.

Need additional assistance?  Please call Medicare at 1-800-633-4227 and speak with a Medicare representative about Medicare plans that are available in your service area.

You can see more 2024 Medicare Part D plan changes using our MA-Compare tool found at: MA-Compare.com/2024 or Browse Medicare Advantage or Part D plans by state and county.

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