MOOP
MOOP — the maximum out-of-pocket — is a Medicare Advantage plan's annual ceiling on what you pay for covered in-network medical care: at most $9,250 in 2026, with many plans setting less. Original Medicare has no MOOP at all — the gap wraparounds and Medigap exist to close.
The number that defines the MA trade
Every MA plan must cap in-network medical cost-sharing (drug costs ride Part D's separate $2,100 cap); PPOs publish a higher combined in-and-out-of-network ceiling too. The MOOP is the honest answer to "what's my worst year" — and the comparison anchor in the Medigap-vs-MA breakeven, where it plays against Medigap's flat premium. Reading tip from the agent-prep page: a low premium with a $9,250 MOOP and a higher premium with a $4,500 MOOP are different products wearing the same ad; the Evidence of Coverage carries the real number. TFL and CHAMPVA households mostly meet MOOP as trivia — their $3,000 family caps already do the job behind Original Medicare.
You earned these benefits. Make them work together.
Whether you keep exactly what you have or add Medicare coverage alongside it, the right answer depends on your health, budget, and how you like to get care.
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