Hi everyone - I am having a discussion with one of my upline managers about this topic and I would like your opinion: I watched a UHC training video on how the $2000 Part D MOOP is calculated. The video said that the $2000 is calculated by taking the TOTAL of what the client pays (deductible + copays) PLUS what the Part D plan pays. When this combined total equals $2000, the MOOP is reached and the client doesn't pay anything else the remainder of the year. I have watched the video several times and I am certain that this is what they are saying. Is this your understanding too?
Part D $2000 MOOP
- Thread starter Nikita
- Start date
- 17,033
This guy explains it well.
- 30,194
Looks to me like Search and Save calculates the $2,000 cap.
For the $2000 MOOP thing, I totally agree with you: it can really get a bit out of hand. To the best of my knowledge, the $2000 only represents amounts that a client pays directly, such as the deducible and co payment among other things other than the plan. So if they spend this much, they do not have to spend a penny more for the rest of the year, at least not while on business. It seems like the video could have given a little different view on it. I think that maybe talking it over with your upline manager could assist in clearing it up!
straightnochaser
Guru
- 955
Incorrect, it includes payments made on their behalf as well.
UHC Zoom meeting said the RX total cost factored in. The slides showed the client paying $47 for T3 on a no deductible plan. In their example in July the client had met the 2K after paying out around $347 out of pocket
MedicareWAA
Guru
- 377
This is not that complicated. Smh.
Two scenarios. What you pay with your plan and what you would have paid with a standard (minimum) part d benefit.
Enrollee pays according to their plan’s benefits. If their OOP would have been higher with the standard design, the higher number is what accumulates to the MOOP.
This is called “greater of” logic.
The prescription payment plan can get hairy. The MOOP does not. It’s very simple.
Two scenarios. What you pay with your plan and what you would have paid with a standard (minimum) part d benefit.
Enrollee pays according to their plan’s benefits. If their OOP would have been higher with the standard design, the higher number is what accumulates to the MOOP.
This is called “greater of” logic.
The prescription payment plan can get hairy. The MOOP does not. It’s very simple.
Ding ding. I’m not sure why people are saying it’s the “Rx total cost”
It’s very simple. MedicareWAA is correct.
