What Happens When You Reach Your Limit?
Once you reach your MOOP Medicare limit, your Medicare Advantage plan will cover what’s left of your OOP costs for eligible services. So, let’s say your plan has a $7,550 out-of-pocket maximum. Immediately your expenditures [1] surpass that amount, you will not be expected to cover anymore costs for in-network, Medicare-covered services. There are certain exceptions to this, besides those, you’re fine! Pretty cool, right?
Once your expenditures surpass that amount, you’re generally not expected to cover anymore costs for in-network, Medicare-covered services. When you reach your maximum OOP limit, you’ll get a message from your plan informing you of such. This message should also let you know what costs (exceptions to the out-of-pocket maximum) you’ll still be responsible for.