What costs count toward the annual out-of-pocket maximum on a Medicare Advantage plan?

Question

Jeffrey Brucculeri · Accepted Answer

If you are referring to the out-of-pocket maximum on the health portion of the plan, it would apply to your deductible and any of your copays, coinsurance payments or Part B drug coinsurance. It does not include any copays you might pay for dental, vision or hearing services. The Part D, prescription drug, True Out-of-Pocket max, is separate. If you have any further questions, feel free to contact me.

Answered by Jeffrey Brucculeri on July 28, 2026

Agent Licensed in OK, KS, MO & TX

Answered by Jeffrey Brucculeri Medicare Insurance Agent

Kelsey Hentzen · Answer

Doctor visit copays, Specialist visit copays, Hospital copays and coinsurance, Outpatient surgery costs, Diagnostic tests (MRI, CT scans, X-rays, lab work), Physical, occupational, and speech therapy, Chemotherapy and radiation therapy, Durable medical equipment (DME)
Dialysis, Emergency room and urgent care copays, Ambulance services, Other Medicare-covered Part A and Part B services. What is typically not included is the prescription costs (Part D).

Andrew Zurbuch, MBA · Answer

A good topic to understand. Out of pocket medical costs that are covered claims. Office visit copays for Doctors, Specialists, a coinsurance percentage for durable medical equipment, & outpatient surgery. Not prescriptions filled at a local pharmacy & not mail order prescriptions. Thank you.

Plans are insured or covered by a Medicare Advantage (HMO, PPO and PFFS) organization with a Medicare contract and/or a Medicare-approved Part D sponsor. Enrollment in the plan depends on the plan’s contract renewal with Medicare. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare to get information on all of your options.

Jaye Maxx Alexander II · Answer

What fully counts to  MOOP - Maximum Out of Pocket  Deductibles ,Co Pays , Co Insurance the monthly premium payments do not count toward  MOOP .

Mike Fields · Answer

The annual out of pocket maximum on costs applies to just about anything that your Plan Carrier was responsible for. Hospital stays, Dr Visits, Tests, Procedures, etc. It does not apply to health items, procedures, Prescriptions or other items that you pay for yourself and wasn't paid through the carrier.

Answered by Mike Fields on July 28, 2026

Agent Licensed in SC, CO, GA, IN & NC

Answered by Mike Fields Medicare Insurance Agent

James Carlson · Answer

All copays  drugs not included. Rehab care will be some oof pocket cost. Premiums not included.  Drugs oop expense

What costs count toward the annual out-of-pocket maximum on a Medicare Advantage plan?

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What costs count toward the annual out-of-pocket maximum on a Medicare Advantage plan?

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