This article explains the difference between MOOP and TrOOP — two separate out-of-pocket limits that appear in Medicare Summary of Benefits documents.

MOOP (Maximum Out-of-Pocket): The annual limit on what a Medicare Advantage member pays out of pocket for Medicare Part A and Part B covered medical services. Once a member reaches the MOOP limit, the plan pays 100% of covered Part A and Part B costs for the rest of the calendar year.

TrOOP (True Out-of-Pocket): The annual threshold for what a Medicare Part D member pays out of pocket for covered prescription drug costs. Once a member reaches the TrOOP threshold, they pay $0 for covered Part D drugs for the rest of the calendar year. For 2026, CMS has set the annual Part D out-of-pocket threshold at $2,100.

Catastrophic coverage: The phase of Medicare Part D coverage a member enters after reaching the TrOOP threshold, at which point the member pays $0 for covered Part D prescription drugs for the remainder of the calendar year.

MOOP stands for Maximum Out-of-Pocket. MOOP applies to Medicare Advantage (Part C) plans and tracks what a member pays out of pocket for Medicare Part A and Part B medical services — including doctor visits, hospital stays, specialist visits, and outpatient care. Once a member reaches the MOOP limit, the plan pays 100% of covered Part A and Part B service costs for the rest of the calendar year. MOOP does not apply to prescription drug costs. In a Medicare Summary of Benefits, MOOP is typically listed under "Your yearly limit(s) in this plan."

TrOOP stands for True Out-of-Pocket. TrOOP applies to Medicare Part D prescription drug coverage and tracks what a member pays out of pocket for covered prescription drug costs. Once a member reaches the TrOOP threshold, they pay $0 for covered Part D drugs for the rest of the calendar year. TrOOP does not apply to medical costs. In a Medicare Summary of Benefits, TrOOP information is found under the Part D Prescription Drug Coverage section.

MOOP and TrOOP do not combine, and spending in one category does not count toward the other.

No. TrOOP does not count toward MOOP. MOOP tracks Part A and Part B medical expenses only. TrOOP tracks Part D prescription drug expenses only. Prescription drug costs do not count toward the MOOP limit. Medical costs do not count toward the TrOOP threshold. The two limits are always tracked and applied separately.

If a client spends $6,000 on hospital and doctor copays during the year, that $6,000 counts toward MOOP. If the same client also spends $2,100 on covered prescriptions, that $2,100 counts toward TrOOP. The prescription drug spending does not reduce the amount remaining before the client reaches their MOOP limit, and vice versa.

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