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What is a MOOP – Maximum Out of Pocket Limit on Medicare Advantage Plans

Posted Dec 03 2009 10:50am
This is a good reminder to take a close look at what your plan will offer for the upcoming year as many now have a limit on what they will pay.  The amount carriers pays varies by companies so if you have one, take a close look and see where you stand.  It is difficult to keep up with all of this I agree and the algorithms for calculating what they do and do not pay for are getting complicated.  BD image

I often say that you don’t know how good (or bad) your insurance is until you get sick. As I’ve been talking to seniors about their Medicare Advantage plans recently, I have seen first-hand how true this is.

A lady told me she paid out $7,000 in co-pays for her cancer treatments two years ago because her Medicare Advantage plan only covered 80% of the cost of radiation and chemo therapy.  I told her that every Medicare Advantage plan covers cancer treatments the same way – leaving seniors with the possibility of large bills if they are diagnosed with cancer.

I also heard the story of a man who paid out $10,000 for chemo and radiation treatment for his prostate cancer earlier this year.  The person telling me this story was worried that he had the same plan as his friend with prostate cancer. But I told him his plan has a MOOP, or maximum-out-of-pocket limit, because he is enrolled in Secure Horizons Medicare Complete Plan 3.  I assumed his friend is enrolled in Secure Horizons Plan 1, because that plan has no MOOP.

For 2010, most Advantage plans will have a MOOP.  Health Net has a $3,400 annual MOOP.  Secure Horizon Medicare Complete Plan 3 has a $3,550 MOOP. Humana’s Gold Plus HMO has a $5,000 MOOP. 

Why is a MOOP important? - Medicare and More

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