What does the out-of-pocket maximum mean in Medicare Advantage plans?

• A. The most a member pays for covered services in a year; after this, the plan covers 100%.
• B. The annual premium.
• C. The deductible for medication only.
• D. The total annual healthcare spending by the plan.

Answer: (A)

The out-of-pocket maximum is the yearly cap on what you pay for covered health care services through a Medicare Advantage plan. It covers your deductibles, copayments, and coinsurance for those services, but it does not include monthly premiums. Once your total payments for covered services reach this limit, the plan covers 100% of the cost of those covered services for the rest of the year, providing protection against very high medical bills. If the plan includes prescription drug coverage, drug costs may be included in the same maximum; if there’s no drug coverage, only medical costs count toward the max.