Wellcare Dual Align (HMO D-SNP): Medical MOOP
MOOP stands for "maximum out-of-pocket" costs, which refers to the annual limit the member will pay out of pocket.
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How To Receive
Details on how to apply
For services you receive from in-network providers. If you reach the limit on out-of-pocket costs, you keep getting Medicare Part A and Part B-covered hospital and medical services and we will pay the full cost for the rest of the year.
You don’t need to “redeem” MOOP—it applies automatically. Always save receipts and monitor your statements to ensure accuracy.
Please note: You must pay your monthly premiums and cost sharing for your Part D prescription drugs. Part D drugs are not counted toward the Maximum Out-ofPocket amount.
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MOOP
Maximum Out-of-Pocket
This is a limit set by the health plan on how much the member has to pay for covered healthcare services in a plan year. This includes deductibles, copayments, and coinsurance but excludes premiums. Once the member reaches their MOOP, the health plan covers 100% of the costs for covered benefits for the rest of the plan year. This cap is designed to protect individuals from excessive healthcare expenses, ensuring financial burden is limited regardless of the amount of care they need.
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