Question

Jennifer is enrolling into a Medicare Advantage (MA) plan and wants to know what counts toward the Out-of-Pocket Maximum. Which of the following is accurate?

Answer 1

The Out-of-Pocket maximum is the limit or cap amount that has to be paid by the insured on an health plan such that the health plans then pays the entire covered health care costs (100%) once the out-of-pocket maximum limit is met by the person insured

The kinds of health care expenditure that count or a applied towards the Out-of Pocket Maximum are:

Deductible: The deductibles are costs that the insured has to pay from his or her pocket before the plan the individual has begins paying for the remainder of the cost. The deductibles are normally for non-preventive care

In some plans, costs such as for prescription drugs have a separate deductible

Coinsurance: This is the cost the insured share with the health plan, once the deductibles cost has been covered by the insured. The coinsurance counts towards the Out-of-Pocket Maximum

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