In a Medicare Advantage Plan, what happens when you reach the MOOP?

• A. The plan pays 100% of covered costs for the rest of the year
• B. The beneficiary pays all costs
• C. Coverage ends
• D. You must switch plans

Answer: (A)

This question tests understanding of the maximum out-of-pocket, or MOOP, in a Medicare Advantage Plan. MOOP is the most you have to pay each year for covered medical services. Once you reach that limit, the plan pays 100% of the costs for all further covered services for the rest of the plan year. In other words, your deductible, copayments, and coinsurance for covered items come to an end for the year once the MOOP is met. This protection does not apply to services that aren’t covered by the plan, and you still owe your premiums. If the plan includes prescription drug coverage, many MA-PD plans have a combined MOOP that also covers drugs after you hit the limit, so you’d owe nothing more for covered drugs either. For example, with a MOOP of $5,000, once you’ve paid $5,000 in covered costs, the plan covers all subsequent covered services for the rest of that year.