CJ Karrer
Writer · Reviewed by Richard ChanUpdated Jun 12, 2026
2 min read
The Maximum Out-of-Pocket (MOOP) limit is a yearly cap on the amount you pay for covered Part A and Part B services in a Medicare Advantage plan.
Once you reach your MOOP limit, your plan pays 100% of the costs for covered services for the remainder of the year.
Original Medicare does not have a MOOP limit, which is why many beneficiaries purchase Medicare Supplement Insurance (Medigap) to help control costs.
The Maximum Out-of-Pocket (MOOP) is a critical feature of Medicare Advantage (Part C) plans designed to protect Medicare beneficiaries from excessive healthcare expenses. MOOP sets a cap on the maximum amount beneficiaries must pay out-of-pocket for covered services within a given plan year. Understanding the MOOP is essential for Medicare beneficiaries to budget and plan for potential healthcare costs and ensure financial protection against high medical expenses. In this article, we explore the concept of the Maximum Out-of-Pocket (MOOP), its significance in Medicare Advantage plans and how it benefits beneficiaries seeking comprehensive healthcare coverage.
In Medicare Advantage (Part C) plans, the MOOP serves as a financial safeguard for beneficiaries. It represents the highest amount a beneficiary is responsible for paying out-of-pocket for covered medical services during a plan year. Once the MOOP is reached, the plan assumes responsibility for covering all further covered services for the remainder of the calendar year.
All costs that beneficiaries pay for covered hospital and medical services count toward reaching the MOOP. This includes deductibles, coinsurance, and copayments for covered services and medications.
Prescription drug costs (for Part D), premiums, payments for services not covered by the plan, and costs incurred for providers outside the plan’s network do not count toward the MOOP.
The MOOP provides several benefits for Medicare beneficiaries:
The Maximum Out-of-Pocket (MOOP) is a crucial element of Medicare Advantage (Part C) plans that sets a cap on the maximum amount beneficiaries must pay out-of-pocket for covered services. By understanding the MOOP and how it operates in their specific plan, Medicare beneficiaries can make informed decisions about their healthcare coverage, budget for potential costs, and ensure financial protection against high medical expenses. The MOOP serves as a valuable tool for beneficiaries seeking comprehensive healthcare coverage while limiting their financial liability, promoting better access to necessary medical care, and fostering overall well-being.