Who Are You Calling a MOOP? Making Sense of ACA’s Acronyms

In Affordable Care Act (ACA) terms, a MOOP is a “maximum out-of-pocket” limit. NSA isn’t the National Security Administration, it’s the No Surprises Act. GFE is a “good faith estimate” and “TiC” is “Transparency in Coverage.” Last, an AEOB is an “advanced explanation of benefits,” that letter you receive or which appears at an insurer or third-party’s web portal explaining how much of a particular health service/product fee was paid. The Department of Labor (DOL), Health and Human Services (HHS) and Treasury issued new FAQs (FAQ Part 60) on July 7 that address issues like balance billing and cost limits for emergency services, non-emergency services provided by nonparticipating providers with respect to a visit to a participating facility, and air ambulance services provided by nonparticipating providers. The FAQs also discuss MOOP limits, specifically, cost sharing for services furnished by a provider, facility, or provider of air ambulance services that is “nonparticipating” for purposes of the NSA, explaining that these expenses are considered cost sharing for purposes of meeting the MOOP limit.

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