This article explains the difference between MOOP and TrOOP — two separate out-of-pocket limits that appear in Medicare Summary of Benefits documents. Understanding the difference between MOOP and TrOOP is essential for agents explaining costs to Medicare clients.
Key Terms
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.
Medicare Part A and Part B: The medical coverage portions of Medicare. Part A covers hospital stays and inpatient care. Part B covers doctor visits, outpatient care, and other medical services. MOOP applies to Part A and Part B costs.
Medicare Part D: The prescription drug coverage portion of Medicare. TrOOP applies only to Part D covered drug costs.
Catastrophic coverage: The phase of Medicare Part D coverage a member enters after reaching the TrOOP threshold. Once in catastrophic coverage, the member pays $0 for covered Part D prescription drugs for the remainder of the calendar year.
What is MOOP?
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.
Per CMS requirements, all Medicare Advantage plans must set a limit on beneficiary cost-sharing for Medicare Part A and Part B services. 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.
In a Medicare Summary of Benefits, MOOP is typically listed under the section titled "Your yearly limit(s) in this plan."
MOOP does not apply to prescription drug costs.
What is TrOOP?
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 under the Part D benefit.
TrOOP determines when a member reaches the annual Part D out-of-pocket threshold and enters catastrophic coverage. For 2026, CMS has set the annual Part D out-of-pocket threshold at $2,100. Once a member reaches the TrOOP threshold of $2,100, they pay $0 for covered Part D drugs for the rest of the calendar year.
In a Medicare Summary of Benefits, TrOOP information is found under the Part D Prescription Drug Coverage section.
TrOOP does not apply to medical costs.
What is the difference between MOOP and TrOOP?
MOOP and TrOOP are completely separate out-of-pocket limits that track different types of spending.
Term | Full Name | Applies To | What It Covers |
MOOP | Maximum Out-of-Pocket | Medicare Advantage medical coverage (Part A + Part B) | Doctor visits, hospital stays, specialists, outpatient care, and other covered medical services |
TrOOP | True Out-of-Pocket | Medicare Part D prescription drug coverage | Covered prescription drug costs under the Part D benefit |
The most important distinction to remember is:
MOOP = Medical costs (Part A + Part B)
TrOOP = Prescription drug costs (Part D)
A member can reach TrOOP without reaching MOOP. A member can reach MOOP without reaching TrOOP. MOOP and TrOOP do not combine, and spending in one category does not count toward the other.
Does TrOOP count toward MOOP?
No. TrOOP does not count toward MOOP. MOOP and TrOOP track entirely different types of spending and are calculated separately.
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.
Example
If a client spends $6,000 on hospital and doctor copays during the year, that $6,000 counts toward the MOOP limit. If the same client also spends $2,100 on covered prescriptions during the year, that $2,100 counts toward TrOOP.
The $2,100 in prescription drug spending does not reduce the amount remaining before the client reaches their MOOP limit. The $6,000 in medical spending does not reduce the amount remaining before the client reaches the TrOOP threshold. Each limit is tracked independently.
Where to find MOOP and TrOOP in a Summary of Benefits
MOOP is listed under the section titled "Your yearly limit(s) in this plan" in the Medicare Advantage Summary of Benefits.
TrOOP is found under the Part D Prescription Drug Coverage section of the Medicare Advantage or standalone Part D Summary of Benefits.
Additional Resources
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