Problem: Ms. Chase is interested in discussing various Medicare Advantage (MA) Plans available in her area with you. She has heard that MA plans have something called a "maximum out-of-pocket" limit. She asks you to explain what this means. What do you say? Need Assignment Help?
a. Original Medicare, not MA plans, have a maximum out-of-pocket limit, for Part A and Part B benefits.
b. MA plans have a maximum out-of-pocket limit, known as the "MOOP" for Part A and Part B benefits. Once a plan member pays a specified amount of cost-sharing, the health plan covers 80 percent of covered medical services.
c. MA plans have a maximum out-of-pocket limit, known as the "MOOP", for Part A and Part B benefits. Once a plan member pays a specified amount of cost-sharing, the health plan covers 100 percent of covered medical services.
d. Each year, CMS specifies an optional MOOP, which health plans can exceed or lower.