Your health plan steps in at this point to help you pay for covered costs. This means you paid off your deductible for the year. Let’s say you receive a $20,000 bill, and you are enrolled in a health insurance plan with the following benefits: Your MOOP “resets” (starts over at zero) every calendar year. Learn more about how to read your maximum out-of-pocket (MOOP) claim.
For instance, in some plans, prescription drugs are not subject to the MOOP limit. Some supplemental benefits are not subject to the MOOP. When you have paid up to the level of your MOOP amount, your plan will start covering 100% of your covered benefits until the MOOP starts over in the next coverage year. Your MOOP does not include your monthly premium payments.ĭuring the calendar year, most payments that you make when receiving care go toward your MOOP amount. Your MOOP helps protect you financially in the event of large or unexpected health care bills. Your maximum out-of-pocket amount is the most that you can pay for covered health care in a calendar year, aside from your monthly premium payments. Also called MOOP amount, out-of-pocket max, out-of-pocket limit
