Out-of-Pocket Maximum
The most you'll pay in a year for covered services in a Medicare Advantage plan before the plan covers 100% of costs.
Reviewed by Aaron Sims, Licensed Life & Health Agent since 2012
Medicare Term
Definition
The most you'll pay in a year for covered services in a Medicare Advantage plan before the plan covers 100% of costs.
The out-of-pocket maximum (also called the MOOP) is the most you'll have to pay out of pocket for covered services during a plan year in a Medicare Advantage plan. Once you reach this limit, the plan pays 100% of covered services for the rest of the year. Original Medicare does not have an out-of-pocket maximum, which is one reason people purchase Medigap policies.
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