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What is MOOP or the Medicare Advantage maximum out-of-pocket limit?

Your Medicare Advantage plan’s MOOP or Maximum Out-of-Pocket limit is the total amount you will spend this year on co-payments and co-insurance for covered or eligible Medicare Part A and Medicare Part B medical services.

When you have reached your plan's annual MOOP limit, your Medicare Advantage plan's eligible medical services are covered for the remainder of the year at no cost to you.

For example, if your Medicare Advantage plan has an annual MOOP limit of $6,700, and you have already spent $6,700 out of pocket for in-network, eligible medical expenses, you will spend $0 for the remainder of the year for your in-network, covered medical costs.

Out-of-network Part A and Part B medical cost may be excluded from MOOP or your plan may have a higher out-of-network MOOP limit.

Some types of Medicare Advantage plans (such as HMOs) may not include out-of-network coverage as part of the plan's MOOP limit.  Please look for language in your Medicare Advantage plan's (MA or MAPD) Summary of Benefits document that may 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 [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."

However, some Medicare Advantage plans (such as HMO-POS plans) include out-of-network coverage as part of the plan's higher-costing MOOP.  Please look in your Evidence Of Coverage (EOC) document for such language as:

As a member of our plan, the most you will have to pay out-of-pocket for in-network covered services in 20[xx] is $6,700. . . . Your plan also has a combined maximum out-of-pocket amount of $10,000. This is the most you pay during the calendar year for covered plan services received from both in-network and out-of-network providers. The amounts you pay for deductibles, copayments and coinsurance for covered services count toward this combined maximum out-of-pocket amount.  . . . If you have paid $10,000 for covered services, you will have 100% coverage and will not have any out-of-pocket costs for the rest of the year for covered services.

When you reach your MOOP, keep paying your premiums.

Once you reach your MOOP limit, your Medicare Advantage plan will contact you and also remind you that you will need to continue paying your Medicare Part B premiums (if paid by you) and Medicare Advantage plan premiums.

Please also remember that MOOP is only for medical services and reaching your MOOP limit does not affect your Medicare Advantage plan’s prescription drug coverage. In other words, you will need to continue paying your prescription drug costs - even after you meet your Medicare Part D out of pocket limit or TrOOP and enter your plan's Catastrophic Coverage.

Your Medicare Advantage plan's MOOP can change every year.

Medicare Advantage plans can change MOOP limits every year and the higher the MOOP, the more you will pay before your medical costs are covered by your plan.  Medicare Advantage plans may also change the MOOP limits for in-network and out-of-network Part A and Part B coverage.  The good news is that Medicare annually sets the maximum MOOP limit for all Medicare Advantage plans - and your Medicare plan's Annual Notice of Change letter (ANOC) will notify you about upcoming changes to your MOOP.

How do MOOP limits change or vary between plans?

MOOP limits can vary from $0 to the Medicare-established annual maximum.  As an example, the most common 2020 Medicare Advantage plan MOOP limits are $6,700 and $3,400.

Percentage of Medicare Advantage Plans
Using Popular MOOP Limits*
Plan Year $6,700 $3,400 $0
2020 24% 10% 2%
2019 34% 13% 3%
2018 39% 14% 3%
2017 36% 14% 6%
2016 35% 17% 7%
2015 38% 23% 4%
2014 25% 26% 10%

Note: *Some Medicare Advantage plans do not have a MOOP limit.  These plans are Medicare-Medicaid Plans and D-SNPs and are not included in the chart above.

You can click on the link in the chart above to see how MOOP limits can vary between Medicare Advantage plans each year.

You can also learn more at: "How are MOOP and TrOOP related? Does your TrOOP go towards meeting your MOOP?"

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Tips & Disclaimers
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
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  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
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  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.