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  • Out-of-Pocket Maximum/Limit (MOOP)

Out-of-Pocket Maximum/Limit (MOOP)

What is MOOP Health Insurance?

The out-of-pocket maximum/limit is the amount you are required to pay for covered services within a specific plan year. Once you reach this limit by paying deductibles, copayments, and coinsurance for in-network care and services, your health plan covers 100% of the costs for covered benefits. The out-of-pocket limit does not include monthly premiums, expenses for services not covered by your plan, out-of-network care and services, or costs exceeding the allowed amount for a service that a provider may charge.

Key Points:

  1. The out-of-pocket maximum is the most you will have to spend on healthcare expenses in a given plan year, ensuring a financial cap on your healthcare costs.
  2. Covered expenses include deductibles, copayments, and coinsurance for in-network care and services.
  3. The out-of-pocket limit does not cover premiums, non-covered services, out-of-network care, or charges exceeding the allowed amount.
  4. The specific out-of-pocket maximum may vary by year and is regulated, but it cannot exceed a set amount. Click here if you have the question, What is an example of an out-of-pocket maximum?

“Glossary.” HealthCare.gov, www.healthcare.gov/glossary/.


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