MOOP: Maximum Out-of-Pocket Coverage

The maximum out-of-pocket (MOOP) limit is the amount you have to pay for covered Medicare services in a year. Medicare Advantage plans have MOOP limits. There is no maximum limit for Original Medicare — Part A and Part B — but a Medigap plan can help cover your Original Medicare out-of-pocket costs.

Terry Turner, writer and researcher for RetireGuide
  • Written by
    Terry Turner

    Terry Turner

    Senior Financial Writer and Financial Wellness Facilitator

    Terry Turner has more than 35 years of journalism experience, including covering benefits, spending and congressional action on federal programs such as Social Security and Medicare. He is a Certified Financial Wellness Facilitator through the National Wellness Institute and the Foundation for Financial Wellness and a member of the Association for Financial Counseling & Planning Education (AFCPE®).

    Read More
  • Edited By
    Lee Williams
    Lee Williams, senior editor for

    Lee Williams

    Senior Financial Editor

    Lee Williams is a professional writer, editor and content strategist with 10 years of professional experience working for global and nationally recognized brands. He has contributed to Forbes, The Huffington Post, SUCCESS Magazine,, Electric Literature and The Wall Street Journal. His career also includes ghostwriting for Fortune 500 CEOs and published authors.

    Read More
  • Reviewed By
    Eric Estevez
    Eric Estevez, Independent Licensed Life Insurance Agent

    Eric Estevez

    Owner of HLC Insurance Broker, LLC

    Eric Estevez is a duly licensed independent insurance broker and a former financial institution auditor with more than a decade of professional experience. He has specialized in federal, state and local compliance for both large and small businesses.

    Read More
  • Published: September 8, 2021
  • Updated: October 20, 2023
  • 7 min read time
  • This page features 11 Cited Research Articles
Fact Checked
Fact Checked

A licensed insurance professional reviewed this page for accuracy and compliance with the CMS Medicare Communications and Marketing Guidelines (MCMGs) and Medicare Advantage (MA/MAPD) and/or Medicare Prescription Drug Plans (PDP) carriers’ guidelines.

Cite Us
How to Cite's Article

APA Turner, T. (2023, October 20). MOOP: Maximum Out-of-Pocket Coverage. Retrieved June 14, 2024, from

MLA Turner, Terry. "MOOP: Maximum Out-of-Pocket Coverage.", 20 Oct 2023,

Chicago Turner, Terry. "MOOP: Maximum Out-of-Pocket Coverage." Last modified October 20, 2023.

Why Trust
Why You Can Trust Us

Content created by RetireGuide and sponsored by our partners.

Key Principles

RetireGuide’s mission is to provide seniors with resources that will help them reach important financial decisions that affect their retirement. Our goal is to arm our readers with knowledge that will lead to a healthy and financially sound retirement.

We’re dedicated to providing thoroughly researched Medicare information that guides you toward making the best possible health decisions for you and your family.

RetireGuide LLC has partnerships with Senior Market Sales (SMS) and GoHealth.

Our partners are able to be reached through the phone numbers and/or forms provided on our website.

The content and tools created by RetireGuide adhere to strict Medicare and editorial guidelines to ensure quality and transparency.

Editorial Independence

While the experts from our partners are available to help you navigate various Medicare plans, RetireGuide retains complete editorial control over the information it publishes.

We operate independently from our partners, which allows the award-winning RetireGuide team to provide you with unbiased information.

Visitors can trust our inflexibility regarding our editorial autonomy. We do not allow our partnership to influence RetireGuide’s editorial content whatsoever.

What Is Maximum Out-of-Pocket Coverage?

Maximum out-of-pocket coverage is essentially a cap on how much you would have to pay out of pocket each year for medical services. The idea is that, once you hit the cap, then your insurance will cover all costs that go beyond that.

The point of MOOP limits is to prevent beneficiaries from being burdened with never-ending or out-of-control expenses due to something like an ongoing health issue that you are continuously receiving treatment for.

It’s important to remember, if you have a plan that includes maximum-out-of-pocket coverage, it will reset at the end of each year. This means that you will once again have to pay out-of-pocket costs in the new year, even if they are for an ongoing health issue.

MOOP only applies to treatments or services that are covered by your insurance. So, even if you hit your out-of-pocket maximum, you will still have to pay for anything that is not covered by your insurance.

Does Original Medicare Have a Maximum Out-of-Pocket Limit?

Original Medicare — Medicare Part A and Part B — does not have a maximum out-of-pocket limit.

Medicare Part A helps cover hospital costs if you are admitted as an inpatient to a hospital. Medicare Part B helps cover your medical costs for doctor office visits and similar health care.

But you have to pay coinsurance and copayments associated with the health care you receive if you have Original Medicare coverage.

Your Share of Costs With Original Medicare
Part A deductible $1,632 per benefit period in 2024
Part A coinsurance (while a hospital inpatient) Days 1-60: $0 for each benefit period
Days 61-90: $408 per day each benefit period
Days 91 and beyond: $816 per day for “lifetime reserve days” (up to 60 in your lifetime)
Beyond lifetime reserve days: All costs
Part B premium $174.70 per month in 2024 (higher if you have a higher income)
Part B deductible $240 in 2024
Part B coinsurance Typically 20% of the Medicare-approved cost of medical services after you’ve met your deductible

Medigap plans — also known as Medicare Supplement insurance — helps cover your out-of-pocket costs if you have Original Medicare. Medigap policies are standardized plans sold through private insurers.

What Is the Maximum Out-of-Pocket for Medicare Advantage?

The federal government sets the maximum out-of-pocket limit for Medicare Advantage plans each year. For 2024, the MOOP limit is $8,850.

Once you hit these limits, you will not owe cost-sharing payments for services you receive for the rest of the year.

The limits are set pretty high; however, according to the Kaiser Family Foundation, most Medicare Advantage plan enrollees’ average cost was lower than the MOOP.

The type of Medicare Advantage plan you have can also affect your average out-of-pocket costs each year.

2023 Average Medicare Advantage MOOP Limit by Plan Type
HMO$0 - $3,650$3,651 - $6,000$6,001 - $8,300
Local PPO$0 - $3,650 (in-network)
$0 - $5,450 (combined)
$3,651 - $6,000 (in-network)
$3,651 - $8,950 (combined)
$6,001 - $8,300 (in-network)
$6,001 - $12,450 (combined)
Regional PPO$0 - $3,650 (in-network)
$0 - $5,450 (combined)
$3,651 - $6,000 (in-network)
$3,651 - $8,950 (combined)
$6,001 - $8,300 (in-network)
$6,001 - $12,450 (combined)

Medicare Advantage plans are also allowed to set their own MOOP limits — so long as they are below the maximum out-of-pocket limits set by the federal government.

Your yearly out-of-pocket costs will vary depending on how many medical services you need, how much they cost, your particular Medicare Advantage plan and multiple other factors. But you will not be required to pay more than the MOOP limit set by Medicare each year.

What Costs Are Credited To Your MOOP?

Copayments and coinsurance for Medicare-approved services apply toward your annual MOOP limit. Your deductible and monthly premiums typically do not apply toward your MOOP.

Medical Services Copayments and Coinsurance That Apply Toward Your MOOP
  • Diagnostic or imaging services
  • Doctor visits
  • Durable medical equipment
  • Emergency room visits
  • Home health care
  • Hospital stays
  • Lab work
  • Medicare-covered outpatient services
  • Prosthetics
  • Skilled nursing facility stays

Typically, any out-of-pocket costs you would have with Original Medicare would apply toward your MOOP limit in a Medicare Advantage plan.

But your Medicare Advantage plan may also allow other out-of-pocket costs — such as vision, dental or hearing services not covered by Original Medicare — to apply to your MOOP as well.

Have you selected your 2024 Medicare plan?
Maximize your Medicare savings by connecting with a licensed insurance agent. Annual Enrollment is open until December 7th.

Are There Out-of-Pocket Maximums for Medicare Part D?

Medicare Part D prescription drug plans do not have an out-of-pocket limit. But they have a set of reduced out-of-pocket payments phased in once you’ve spent certain amounts out-of-pocket.

Medicare Part D Out-of-Pocket Costs
This is the amount you have to pay out-of-pocket before your Part D plan kicks in. It varies depending on your plan, but is limited to $545 in 2024.
Initial Coverage
Once you meet your deductible, your plan will pay a portion of your prescription costs. You will be responsible for a copayment or coinsurance until you have typically paid $5,030 out-of-pocket.
The Donut Hole
The Medicare Part D donut hole — also called the coverage gap — kicks in when you have spent $5,030 (in 2024) out-of-pocket on covered drugs. After that, you are responsible for 25% of the cost of your drugs.
Catastrophic Coverage
Catastrophic coverage kicks in when you have spent $8,000 out-of-pocket for drugs covered in your plan. In 2024, once you reach catastrophic coverage you will not have to pay a copayment or coinsurance for covered Part D drugs.

Are There Out-of-Pocket Maximums for Medigap?

Only two of the 10 standardized Medigap plans — Plan K and Plan L — have maximum out-of-pocket limits. The Medigap Plan K out-of-pocket limit for 2024 is $7,060. The limit for Plan L is $3,530.

While most Medigap plans cover 100% of many Medicare out-of-pocket costs, Plans K and L cover only a percentage of most costs. This is part of the reason these two plans have an out-of-pocket limit.

Medigap Plan K and Plan L Coverage Compared
Covered ServicePlan K Coverage Plan L Coverage
Medicare Part A coinsurance and hospital costs up to 365 days after Medicare benefits are exhausted100%100%
Medicare Part A deductible50%75%
Medicare Part A hospice care coinsurance50%75%
Skilled nursing facility care coinsurance50%75%
Medicare Part B coinsurance or copayment50%75%
First three pints of blood for medical procedures each year50%75%

Once you meet your yearly out-of-pocket limit for Plan K or Plan L — along with your yearly Medicare Part B deductible — your Medigap plan will pay 100% of your covered services for the rest of the calendar year.

How Can I Cover My Out-of-Pocket Costs?

In addition to a Medigap plan — designed to cover out-of-pocket costs related to Original Medicare — there are other options to help with out-of-pocket costs.

But Medigap only works with Original Medicare and cannot be used with a Medicare Advantage plan.

Options to Help With Medicare Out-of-Pocket Costs
Medicare Medical Savings Account (MSA) plans
Medicare MSA plans are provided through private insurers and must be used with a high deductible Medicare Advantage plan. You deposit money into your Medicare MSA plan to cover health care costs before you meet your deductible.
Medicare Savings Programs
There are four Medicare Savings Programs that help people with low incomes and limited resources cover out-of-pocket Medicare costs. The programs require you to live in the U.S., be 65 or older, receive Social Security disability benefits or meet other income and resource requirements.
Health savings account (HSA)
Health savings accounts must be used with high-deductible health plans. Once you enroll in Medicare, you can no longer contribute to an HSA. But you can still use the money in your HSA to pay for certain Medicare out-of-pocket costs.

Also, remember that Original Medicare and Medigap do not cover out-of-pocket expenses for most vision, dental and hearing services — but a Medicare Advantage plan may cover these.

Last Modified: October 20, 2023

11 Cited Research Articles

  1. National Council on Aging. (2023, October 13). What You'll Pay in Out-of-Pocket Medicare Costs in 2024. Retrieved from
  2. U.S. Centers for U.S. Medicare & Medicaid Services. (2023, October 12). 2024 Medicare Parts A & B Premiums and Deductibles. Retrieved from
  3. U.S. Centers for Medicare & Medicaid Services. (2023, September 26). Medicare Advantage and Medicare Prescription Drug Programs to Remain Stable in 2024. Retrieved from
  4. U.S. Centers for Medicare & Medicaid Services. (2023, July 31). Center for Medicare. Retrieved from
  5. U.S. Centers for Medicare & Medicaid Services. (2023, July 31). Yearly Deductible for Drug Plans. Retrieved from
  6. (2023). Catastrophic coverage. Retrieved from
  7. (2023). Costs in the Coverage Gap. Retrieved from
  8. (2023). Costs of Medigap Policies. Retrieved from
  9. (2023). Monthly Premium for Drug Plans.
  10. Centers for Medicare & Medicaid Services. (n.d.). Helping People in Medicare Advantage Plans and Medicare Drug Plans Understand Their “Explanation of Benefits” (EOB). Retrieved from
  11. Centers for Medicare & Medicaid Services. (n.d.). Medicare Medical Savings Account (MSA) Plans. Retreived from