What Are These Exceptions?
In most cases, you’ll still be on the hook for costs that don’t count toward your limit. For example, you’ll still pay premiums, such as the Part B premium that may be included in your Medicare plan. (Your monthly Medicare Advantage premiums don’t count toward your limit.) You’ll also still be asked to pay for drug costs, since they don’t count toward your MOOP limit either. Even after you reach the out-of-pocket maximum, your plan may not cover services outside of your plan’s network.
Another common exception to Medicare Advantage out-of-pocket maximum spending deals with your plan’s network. As stated earlier, even after you hit the out-of-pocket maximum, your plan may not account for services outside of your plan’s network. Some plans also have a higher maximum OOPC limit that involves out-of-network costs. When you meet this type of limit, your plan will then cover eligible out-of-network costs. Additionally, if a service isn’t covered by your Medicare Advantage plan, your plan still won’t cover those costs.