Did You Know: Maximum Out-Of-Pocket Limit

What happens to your maximum out-of-pocket (MOOP) if you change plans throughout the year in the Open Enrollment Period (OEP) or from a life qualifying event that gives you a Special Enrollment Period (SEP)?

Your out-of-pocket expenses from your Part A & B of coverage towards your new plan’s MOOP limit will follow you if you change plans.

As noted by the Centers for Medicare and Medicaid Services (CMS) in the Medicare plan manuals:

"During a contract year, when an enrollee switches to another [Medicare Advantage] plan of the same type (for example, from one HMO to another HMO) offered by the plan, his/her accumulated annual contribution toward the annual MOOP limit in the previous plan to date is to be counted towards his/her MOOP limit in the new MA plan. As applicable, this transfer of MOOP applies to both in-network and out-of-network MOOP."

However, CMS does provide some flexibility so companies can allow your MOOP to transfer between Medicare Advantage plans even when the plans are not similar (for example, you were in an Aetna HMO and join an Aetna PPO).  The Medicare Advantage plan manual continues on to note:

"Additionally, MA [Medicare Advantage] plans may extend the transferability of the enrollee’s contribution toward his/her annual MOOP so that it applies to an enrollee’s transfer during the contract year to any MA plan type offered by the MAO [Medicare Advantage Organization].  For example, if an enrollee makes a mid-year change to move from an HMO to a PPO offered by the same MAO, his/her current contribution toward the MOOP limit may follow the enrollee and be counted towards the MOOP limit in the PPO.  This allows those enrollees who are eligible to make mid-year plan changes to freely select among the diverse MA plan options offered by an MAO."