What is MOOP in MA plans and its practical effect?

• A. The annual limit on out-of-pocket costs; once reached, plan pays 100% of covered costs for the rest of the year
• B. MOOP is the minimum out-of-pocket limit
• C. MOOP is a monthly cap on pharmacy costs
• D. MOOP determines premium amount

Answer: (A)

MOOP is the maximum out-of-pocket limit in Medicare Advantage plans. It’s an annual cap on how much you pay in cost-sharing for covered services. When you reach that limit, the plan covers 100% of your covered costs for the rest of the year, providing protection against very high medical bills. What counts toward MOOP includes deductible, copayments, and coinsurance for services that are covered by the plan; premiums do not count toward this limit. In MA plans that include prescription drug coverage, drug costs typically count toward the MOOP as well, so once you hit the cap you wouldn’t pay additional out-of-pocket costs for covered medical services or drugs for the remainder of the year.