What happens after the out-of-pocket maximum is reached?

• A. The insured must pay double for all subsequent services.
• B. Deductibles reset and start over.
• C. Coinsurance increases.
• D. The insurer pays 100% of covered costs.

Answer: (D)

Once the out-of-pocket maximum is reached, the plan covers 100% of the costs for any additional covered services for the rest of the policy year. This cap protects you from paying more once you’ve spent enough on deductibles, coinsurance, and copays. Premiums aren’t affected by hitting this limit, and the protection typically applies only to services the plan covers; if a service isn’t covered or you go out of network, different rules may apply. In short, after meeting the out-of-pocket maximum, your personal cost-sharing ends for covered services for the remainder of the year.