APTA Communication, Stress, Healthcare Systems, And Professional Roles In Physical Therapy Practice Test

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

Insurance pays 100% of covered costs. Insurance stops paying entirely. The patient must pay everything. Only preventive services are covered.

Correct Answer:

Insurance pays 100% of covered costs.

Explanation:

After you reach the out-of-pocket maximum, your insurance covers 100% of the costs for covered services for the rest of the plan year. This cap means you no longer pay coinsurance or copays for those in-network, covered services, though premiums aren’t counted toward the max and some plans have nuances for out-of-network or non-covered services. The other statements don’t fit because reaching the max does not stop insurance from paying, it doesn’t require you to pay everything for the remainder of the year, and it isn’t limited to just preventive services.

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