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CMS Final Rule: CY2023 Medicare Advantage Plans' Maximum Out-of-Pocket (MOOP) Limits

Posted Jan 05, 2023

Effective 1/1/2023, the maximum out-of-pocket (MOOP) limit for a Medicare Advantage (MA) plan (after which the plan pays 100% of MA costs) will be calculated based on the accrual of all Medicare-covered cost sharing.

Effective 1/1/2023, the maximum out-of-pocket (MOOP) limit for a Medicare Advantage (MA)
plan (after which the plan pays 100% of MA costs) will be calculated based on the accrual
of all Medicare-covered cost sharing, not the supplemental benefits, in the plan benefit.
This accrual includes Medicare cost sharing when the beneficiary, Medicaid, or secondary
insurance pays for it, or when it remains unpaid.

Reimbursement to providers will shift from Medicaid/secondary payors to the Medicare plan
after the member reaches the MOOP limit

Download the Provider Alert: 1511 22 MA MOOP Calculation Provider Alert v5 FINAL wr