A Guide to Medicare Advantage’s Maximum Out-of-pocket

Medicare Advantage keeps growing its popularity, and you may want to get it as it looks promising because of the demand. However, there are still some things you need to know about it, like its out-of-pocket maximum. Unlike in Traditional Medicare, you can’t use Medigap to balance out-of-pocket costs with Medicare Advantage. 

Determining your out-of-pocket maximum in Medicare Advantage can be quite confusing as it offers various options to choose from. Medicare Advantage covers the coverages of both Medicare Part A and B and most of the time, Part D too. And among these varies the cost of the premium,  coinsurance, deductibles, and out-of-pocket. But the good news is Medicare Advantage has its annual out-of-pocket limits, known as Maximum-Out-Of-Pockets or MOOP.
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Below is the run-through of cost-sharing in the Medicare Advantage Plan:

• Out-of-pocket limitations
  The maximum out-of-pocket in Medicare Advantage is $6,700 (for in-network expenses). Meaning, the plan can’t ask you to pay more beyond this. 
• OOP limit levels 
  If you get your medical services from out-of-network doctors or hospitals, the plan will set two out-of-pocket limits. The one is for the in-network, while the other one is for the combined in-network and out-network. The combined in-network and out-network is $10,000 depending on the type of plan you get.
• Medicare Advantage Premium
  The monthly premium isn’t included in your out-of-pocket maximum.
• Part D Plan
  In case you include Part D or Prescription Drug Coverage in your Medicare Advantage, it won’t be counted in the MOOP. Part D has its own out-of-pocket limits. 

Here are the costs that will be credited in Medicare Advantage Maximum Out-of-pocket:

• Coinsurance/copayments for medical checkups, ER visits, hospital stay, and services for covered outpatients
• Coinsurance/copayments for medical equipment 
• Coinsurance/copayments for stays in nursing facilities
• Coinsurance/copayments for health care at home

Conclusion
Even without Medicare Supplement, there are still some ways to help you with your out-of-pocket expenses like maximum out-of-pocket. However, Medicare Advantage Plans do change their maximum out-of-pocket every year. And this 2021, we should expect an increase of MOOP up to $7,550. You don’t need to worry as these changes aren’t sudden. You’ll get an Annual Notice of Change letter from your Medicare plan to notify you if there will be changes soon. 

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