What is Plan A's out-of-pocket maximum in the example?

What is Plan A's out-of-pocket maximum in the example?

• A. $1,000
• B. $500
• C. $1,500
• D. $2,000

Answer: (A)

Out-of-pocket maximum is the maximum you pay for covered services in a plan year; once you reach that amount, the plan covers 100% of covered services for the rest of the year. It includes deductible, copays, and coinsurance, but not your monthly premium. In Plan A’s example, the out-of-pocket maximum is $1,000, so after you’ve paid $1,000 in combined deductible, coinsurance, and copays for covered services, the plan pays 100% of further covered expenses for the year. Premiums don’t count toward this limit. The other dollar amounts would imply a different cap than what the example shows.

Out-of-pocket maximum is the maximum you pay for covered services in a plan year; once you reach that amount, the plan covers 100% of covered services for the rest of the year. It includes deductible, copays, and coinsurance, but not your monthly premium. In Plan A’s example, the out-of-pocket maximum is $1,000, so after you’ve paid $1,000 in combined deductible, coinsurance, and copays for covered services, the plan pays 100% of further covered expenses for the year. Premiums don’t count toward this limit. The other dollar amounts would imply a different cap than what the example shows.