What is MOOP in Medicare Advantage?
MOOP, or Maximum Out-of-Pocket, is the highest amount you will pay for covered healthcare services in a Medicare Advantage (Part C) plan during a calendar year. Once you reach this limit, your plan covers 100% of eligible costs for the rest of the year.
This is different from Original Medicare (Parts A & B), which does not have a MOOP, meaning your out-of-pocket costs can be unlimited unless you have supplemental coverage like Medigap.
How MOOP Works in Medicare Advantage
Every Medicare Advantage plan must include a MOOP limit that applies to covered medical services. Here’s how it functions:
- You Pay for Services – Throughout the year, you pay deductibles, copayments, and coinsurance for covered healthcare.
- MOOP Limit Reached – Once your out-of-pocket spending reaches the MOOP amount set by your plan, you stop paying for covered services.
- Plan Covers 100% of Costs – Your plan covers all in-network, covered medical expenses for the rest of the year.
Important: MOOP applies only to covered services. You’ll still have to pay for non-covered services, out-of-network care (if not included), and monthly premiums.
MOOP Limits for Medicare Advantage Plans in 2025
- In-Network MOOP: $8,550 (maximum allowed by Medicare)
- Out-of-Network MOOP: Plans that cover out-of-network services often have a higher combined MOOP limit.
Some plans may offer lower MOOP limits to attract enrollees, so it’s worth comparing options.
What Counts Toward Your MOOP?
✔️ Deductibles
✔️ Copayments
✔️ Coinsurance
What Does NOT Count?
❌ Monthly Medicare Advantage premiums
❌ Prescription drug costs (Part D expenses have separate cost limits)
❌ Dental, vision, or hearing costs (unless covered by your plan)
MOOP vs. Other Medicare Costs
| Cost Type | Original Medicare (A & B) | Medicare Advantage (Part C) |
|---|---|---|
| Deductible | Yes | Yes |
| Copayments & Coinsurance | Yes | Yes |
| MOOP Limit | No | Yes (varies by plan) |
| Premiums Count Toward MOOP? | No | No |
If you’re concerned about high medical bills, a Medicare Advantage plan with a low MOOP can help protect against excessive out-of-pocket costs.
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How to Choose a Medicare Advantage Plan with a Good MOOP
When comparing plans, consider:
- MOOP Limit – A lower MOOP is better if you expect high healthcare usage.
- In-Network vs. Out-of-Network MOOP – HMO plans usually have lower MOOPs than PPOs.
- Extra Costs – Look at monthly premiums, drug costs, and additional benefits like dental or vision.
To compare MOOP limits for available plans, visit our Medicare Advantage Plan Finder page.
Final Thoughts: Why MOOP Matters
MOOP is a crucial feature of Medicare Advantage plans because it helps control healthcare expenses.
✔ Helps budget for healthcare costs
✔ Protects against excessive medical bills
✔ Varies by plan, so comparing options is essential
Would you like help finding a Medicare Advantage plan with a low MOOP in your area?
Frequently Asked Questions About MOOP in Medicare Advantage
What happens if I reach my MOOP in Medicare Advantage?
Once you hit your MOOP, your Medicare Advantage plan covers 100% of eligible medical costs for the rest of the year.
Does MOOP reset every year?
Yes, MOOP limits reset at the start of each calendar year. Your spending starts over from zero on January 1.
Does MOOP include prescription drug costs?
No, MOOP applies only to medical expenses. Part D prescription drug costs follow a different cost structure with separate spending limits.
Is the MOOP the same for all Medicare Advantage plans?
No, MOOP limits vary by plan. While Medicare sets a maximum allowable amount each year, some plans may offer lower limits.
Does Original Medicare have a MOOP?
No, Original Medicare (Parts A & B) does not have a maximum out-of-pocket limit. Without additional coverage, such as Medigap or Medicare Advantage, there is no cap on your medical expenses.