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Dear Matt,

I understand what a Medicare Advantage is, and what the annual Medicare Advantage Maximum Out of Pocket (MOOP) is.
Is that set by the Medicare Advantage insurance company or by Medicare? Can my MOOP ever go down?

Thanks,

Allison M.


Allison,

As I outline in my book, the Medicare Advantage Out of Pocket Maximum (MOOP) is found on all Medicare Advantage plans. It limits the amount of annual medical spending financial exposure you have in a calendar year.  A MOOP is financial protection should you have a bad health year accompanied by very expensive medical bills. It limits how much money—worst case scenario—you’d have to pay out of your pocket during a year.

In insurance-speak, these are also called Annual Maximums, stop-loss amounts, annual plan maximums, or some other variation of those terms, but the concept is the same. Once you spend a certain amount, you’re done paying out of your pocket, and the insurance company covers 100%

Yes, it’s set by the Medicare Advantage insurance company and yes, it can go down.  It can go up, too.

2023 Medicare Advantage Changes

Big changes to a particularly important benefit of Medicare Advantage plans are on the way for 2023. It’s going to be very, very important for those of you on, or considering buying Medicare Advantage plans this fall to read your policy details, because your annual Maximum Out Of Pocket (MOOP) could be going up by more than 10%!

Medicare insurance companies file their plan designs for their Medicare Advantage plans in June of the prior year. So right now, Medicare already knows what your Medicare Part D and Medicare Advantage premiums and benefits will be in January, 2023. You won’t see those until October of this year, when the Annual Election Period begins (Oct 15-Dec 7).

One of the BIG changes CMS/Medicare made this year has so far (inexplicably) flown below the radar of just about every media outlet out there. It’s a matter of public record, but you have to dig to find it.

Those of you who read my book know that I really focus in on paying attention to your MOOPs, and urge you to only consider Medicare Advantage plans with around a $4,000 annual MOOP. MOOPs used to be limited to a maximum amount of $6,700 for many years. A few years ago, Medicare raised that maximum amount allowable to $7,550, which was a big jump, percentage-wise.

They just did it again.

2023 Medicare Advantage Out of Pocket Maximums

In 2023, Medicare is allowing Medicare Advantage insurance companies to place MOOPs at a maximum of $8,300, an increase of 10.3% over last year’s max of $7,550. If you’re on a Medicare Advantage PPO or HMO-POS with out-of-network benefits, the total MOOP can’t exceed $12,450 which is also a 10% increase from 2022.

2023 Medicare Annual Notification of Change – Pay Attention!

Even if your MOOP doesn’t go up to the maximum in 2023, I’m predicting many will rise. So keep that in mind when your Medicare insurance company sends you your Annual Notification of Change this fall. By statute, they must do this by October 1 (but sometimes it’s a bit late, normally due to the USPS). You’ll have to dig a bit to find it, but make sure you check!

To your wealth, wisdom, and wellness!

-Matt Feret

 

I love answering Medicare questions. Send me yours by clicking here and I’ll pick a few for a future blog post!

Related Articles:

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How Can I Tell If My Medicare Advantage Maximum Out of Pocket (MOOP) Changed?

Author Bio: Matt Feret is the author of the Prepare for Medicare book series and launched prepareformedicare.com to help people get objective answers to questions about Medicare. He’s also the host of The Matt Feret Show.

He’s held leadership roles at numerous Fortune 500 Medicare health insurers in sales, marketing, operations, product development and strategy for over 20 years.  Matt holds a BA from Virginia Tech and an MHA from Washington University in St. Louis.

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