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

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Study for the Federally Facilitated Marketplace (FFM) Exam with flashcards and multiple choice questions. Each question includes hints and explanations to help you prepare. Ace your exam today!

Multiple Choice

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

Explanation:
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.

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