Do Medicare Advantage payments count towards my “out of pocket” maximum?

Your out-of-pocket costs will be limited by your plan’s Maximum Out-Of-Pocket (MOOP) limit for Medicare Advantage plans. If you are enrolled in a PPO, your plan will set two MOOPS’s, one for in-network costs and another for a combination of in-network and out-of-network costs. In 2021, the maximum allowable MOOP for Medicare Advantage Plans is $7,550, but plans can set lower limits if they choose. So what things contribute to reaching your MOOP? Your out-of-pocket costs in the form of copays, coinsurance, and deductibles contribute to meeting your MOOP. Once your MOOP is met, you will no longer have to pay any more out of pocket. It is essential to understand that only out-of-pocket costs for the medical side of your Medicare Advantage plan contribute to your MOOP. Part-D prescription drug costs are excluded, as are your plan premiums.

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