If your client decides to change Medicare Advantage (MA) plans during the year, one important question is: Will the out-of-pocket costs they’ve already paid carry over to the new plan? This is where the concept of the Maximum Out-of-Pocket (MOOP) transfer comes into play.
What Is a MOOP Transfer?
MOOP is the maximum amount a beneficiary pays for covered services under Medicare Part A and Part B before the plan pays 100% of the costs. When switching MA plans mid-year, the amount your client has already spent out-of-pocket can sometimes transfer to the MOOP limit of the new plan—but only under certain conditions.
When Does MOOP Transfer?
MOOP transfers are possible in these cases:
- Same Insurance Carrier or Medicare Plan Sponsor:
If your client’s new MA plan is offered by the same insurance company or Medicare plan sponsor, and they are moving into the same type of plan (for example, switching from one HMO to another HMO or one PPO to another PPO), the MOOP typically transfers. - Different Type of Plan with the Same Carrier:
Some insurance carriers allow MOOP transfers if your client switches plan types but stays with the same carrier. For example, moving from a Medicare Advantage HMO plan to a Medicare Advantage PPO plan under the same sponsor may allow a MOOP transfer.
When Doesn’t MOOP Transfer?
If your client switches to a plan from a different insurance carrier or to a completely different plan type without MOOP transfer provisions, the out-of-pocket costs will not transfer. Your client will start accumulating expenses toward the new plan’s MOOP from zero.
Why Is This Important?
Confirming whether MOOP transfers apply helps your clients avoid unexpected out-of-pocket costs and better manage their healthcare expenses throughout the year. Always recommend checking directly with the new plan provider to see if they allow MOOP transfers before making a change.
By understanding MOOP transfers, you can better guide your clients through switching Medicare Advantage plans with confidence and clarity.
Contact National Insurance Markets for more information.
