Medicare Advantage Maximum Out-of-Pocket (MOOP) in 2025

Medicare Advantage maximum out-of-pocket (MOOP) is the annual cap set on how much a customer spends before insurance covers 100% of approved health insurance costs.

The purpose of Medicare out-of-pocket costs is to limit the amount customers have to spend on healthcare each year. Read on to learn more about Medicare Advantage MOOP, the cost of Medicare Advantage, and more.

Speak with a licensed insurance agent today about your Medicare needs by calling (855) 634-0435. Or, you can enter your ZIP in our free tool for quotes.

Medicare Advantage MOOP Explained

Do Medicare Advantage plans have a cap? Yes, when you buy a Medicare Advantage Part C plan, your plan will have an annual maximum out-of-pocket amount that caps what you have to spend.

Once you have spent this amount on deductibles, copayments, and similar healthcare costs, your Medicare Advantage plan will cover the rest of your healthcare costs.

Medicare Advantage MOOP Overview

The standard Part C maximum out-of-pocket is $9,400 for in-network costs and $14,000 total. Once you hit those amounts for the Part C MOOP, your plan will cover the rest of your costs.

This can provide some peace of mind to customers in the event of a major medical event, as they won’t have to pay all of the unexpected medical expenses if they meet their maximum out-of-pocket.

With an Original Medicare plan, you won’t have a maximum out-of-pocket amount like you do with Medicare Advantage unless you get Medicare Supplemental Insurance (Medigap).

Because of this, a Medicare Advantage plan may be more attractive to some customers over a Medicare Original plan, as the maximum cap limits costs.

Medicare Advantage MOOP Exceptions

For example, MOOP wouldn’t apply to a cosmetic procedure that is deemed not medically necessary by insurance. It is important to note that the Medicare Advantage MOOP does not apply to premiums and non-covered care.

Medicare Advantage MOOP Key Details

Medicare Part C MOOP will also exclude the cost of Part D coverage, which is a prescription drug coverage add-on.

Because your Medicare Advantage MOOP resets every year, you may not always reach the MOOP and get 100% of costs covered if you don’t have many medical visits.

However, if you reach the MOOP, your costs will be covered for the rest of the year, even if it’s just for a short period.

For example, if you reach your out-of-pocket maximum in October, you will have about two months of complete coverage before you have to start paying deductibles, copays, and coinsurance again.

Learn More: Medicare Advantage vs. Original Medicare

Comparing Medicare Advantage (Part C) Costs

How much does Medicare cost? Medicare Advantage plans have varying deductibles and drug coverage, depending on the provider you choose.

On average, Medicare Advantage premiums are typically around $17 per month at most insurance companies.

Medicare Advantage (Part C) Plan Costs

Medicare Advantage Part C plans may also come with some benefits, such as added dental or vision coverage, which will raise premiums and out-of-pocket costs.

It depends on the insurance provider you choose, as not all providers will offer added benefits like these.

Always compare multiple Part C plans based on premiums and maximum out-of-pocket costs to find coverage that fits your budget.

You should also consider your current group plan, individual health insurance, or dental coverage, as they might be more cost-effective based on your age and employment.

Deciding if Medicare Advantage is Right for You

Medicare Advantage plans may not be right for every customer. While a Medicare Advantage MOOP can help cap costs, Medicare Advantage can still be expensive.

The biggest cost that Medicare Advantage customers will need insurance for is hospital stays, accounting for 29% of Medicare Part C costs.

Doctor visits, medical equipment, therapy, and home care are other reasons you might want to shop around for affordable Medicare Advantage plans.

Take the time to fully consider the pros and cons of the Medicare Advantage maximum out-of-pocket, as well as taking the time to choose what Medicare parts you want on your plan (Read More: Medicare Parts A, B, C, & D).

Medicare Advantage MOOP Pros & Cons

Some customers may also find it difficult to track the amount spent toward the maximum out-of-pocket for Medicare Advantage, leaving them unsure when they will meet their MOOP.

To speak with a licensed insurance agent about your Medicare needs, call (855) 634-0435 today. You may also enter your ZIP in our tool for free quotes.