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Why is a MOOP important?

why is medicare important

I often say that you don’t know how good (or bad) your insurance is until you get sick. As I’ve been talking to seniors about their Medicare Advantage plans recently, I have seen first-hand how true this is.

A lady told me she paid out $7,000 in co-pays for her cancer treatments two years ago because her Medicare Advantage plan only covered 80% of the cost of radiation and chemo therapy.  I told her that every Medicare Advantage plan covers cancer treatments the same way – leaving seniors with the possibility of large bills if they are diagnosed with cancer.

I also heard the story of a man who paid out $10,000 for chemo and radiation treatment for his prostate cancer earlier this year.  The person telling me this story was worried that he had the same plan as his friend with prostate cancer. But I told him his plan has a MOOP, or maximum-out-of-pocket limit, because he is enrolled in Secure Horizons Medicare Complete Plan 3.  I assumed his friend is enrolled in Secure Horizons Plan 1, because that plan has no MOOP.

A few years ago, most Medicare Advantage plans had no annual MOOP, and the

people involved in the above stories, obviously were in such plans.  For 2010, most Advantage plans will have a MOOP.  Health Net has a $3,400 annual MOOP.  Secure Horizon Medicare Complete Plan 3 has a $3,550 MOOP. Humana’s Gold Plus HMO has a $5,000 MOOP.

Having a MOOP means that if a person gets sick with cancer, or is in and out of the hospital multiple times, their co-pays are capped by the MOOP.  So if a person is diagnosed with cancer and enrolled in a Health Net plan, they will stop paying co-pays for the rest of the year once they hit $3,400.  This is a good safety net.

But many people are enrolled in plans with no MOOP and they won’t know it until they get sick and are hit with huge medical bills- unless they look at the materials they recently received from their Medicare Advantage plan.  Unfortunately, most people I’ve met with had not opened the package from their Medicare Advantage plan.  This is the time of year for everyone to review their plan and determine if it is as good as it used to be – or if they should shop for a better plan.

Category: Insurance

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