Glossary Term

Maximum Out-of-Pocket

A maximum out-of-pocket costs (MOOP) defines the limit of patient out-of-pocket spending on in-network medical care covered under a health plan during a single enrollment year. Once a patient’s out-of-pocket medical spending reaches the MOOP limit, the patient does not have additional cost-sharing obligations on covered medical care for the remainder of the plan year. Upon commencement of a new plan year, the prior year’s out-of-pocket spending is ignored as the MOOP limit considers patient out-of-pocket spending within the new plan year. 

MOOP limits may be different for out-of-network care, or the MOOP may not apply at all with respect to money spent on out-of-network health care providers. Additionally, health insurance premiums do not count toward the annual MOOP limit. 

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