MOOP

MOOP is an acronym standing for “maximum out-of-pocket” costs. The MOOP is the limit on annual out-of-pocket expenditures paid by a health plan enrollee for medical services that are covered by a health insurance plan.

After a MOOP is satisfied during a given plan year, the health insurance plan enrollee does not pay additional cost-sharing for covered medical services until the next coverage period (which often begins at the start of a new calendar year). For example, imagine a health insurance plan has a $7,000 MOOP. An enrollee in this health plan has a major medical event early in the year and spends $7,000 on deductibles, copayments, and co-insurance fees. For the remainder of the year in this example, this enrollee would not pay any more on deductibles, copayments, or co-insurance for medical services that are covered by the health plan. Any medical services not covered by the health plan would not be affected by the MOOP. At the start of the new year, the enrollee would begin to pay deductibles, copayments, or co-insurance because a new coverage period has begun and the MOOP has not been satisfied for that coverage period.

A MOOP is a tool to protect a health plan enrollee from catastrophic medical costs that can occur despite the presence of health insurance coverage.

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