Which statement is true about the Medicare Advantage (MA) out-of-pocket maximum?

• A. All MA plans have no out-of-pocket maximum.
• B. The out-of-pocket maximum is only for drug costs.
• C. MA plans have no out-of-pocket maximum.
• D. Out-of-pocket maximum applies only in catastrophic coverage.

Answer: (C)

Understanding the out-of-pocket maximum in Medicare Advantage centers on the annual cap on what you pay for covered services. MA plans include a maximum out-of-pocket limit that stops further out-of-pocket costs once you reach it in a calendar year. This cap applies to most in-network medical services, and if the plan includes drug coverage, you typically count drug costs toward that same limit, giving you a single annual cap for medical and prescription costs combined. Original Medicare does not have an MOOP, and catastrophic coverage does not create a separate hard cap. So the idea that MA plans lack an out-of-pocket maximum or that the limit only applies to drugs or only during catastrophic coverage isn’t accurate—the hallmark of MA is the plan-wide MOOP to protect you from very high costs, with drugs counting toward it if included.