Which term describes the maximum limit on a member's annual costs for Medicare-covered services in a Medicare Advantage plan?

• A. Out-of-pocket minimum
• B. Out-of-pocket maximum
• C. Premium cap
• D. Deductible cap

Answer: (B)

Out-of-pocket maximum describes the maximum you pay out of pocket for Medicare-covered services in a Medicare Advantage plan during a plan year. It covers cost-sharing like copays, coinsurance, and deductibles for those services. When you reach that limit, the plan pays 100% of covered services for the rest of the year, within the plan’s rules. Premiums are separate and do not count toward this cap. If the plan includes prescription drug coverage, there may be a separate drug out-of-pocket maximum or a combined maximum for medical and drug costs.