A policy has a $1,000 annual deductible, 80/20 coinsurance, a $50 copay for office visits, and a $5,000 maximum out-of-pocket. Which statement correctly describes how these cost-sharing features work together?

Question

Accepted Answer

The insured pays 100% of covered expenses until the deductible is met, then 20% of covered expenses until the maximum out-of-pocket is reached

Answer

The copay and the deductible both apply fully to every office visit

Answer

Once the deductible is met, the insurer pays 100% of all future expenses with no further cost-sharing

Answer

The maximum out-of-pocket replaces the deductible, so the insured pays nothing until $5,000 is reached

A policy has a $1,000 annual deductible, 80/20 coinsurance, a $50 copay for office visits, and a $5,000 maximum out-of-pocket. Which statement correctly describes how these cost-sharing features work together?

Related Practice Questions