Medical Expense✓ Verified · outline & fact-checked · Sep 2026Difficulty 2/5
Which cost is NOT counted toward a health plan's annual out-of-pocket maximum?
Select an option to reveal the answer and the full 3-part explanation — free, no signup.
Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
The annual out-of-pocket maximum is the most the insured can be required to pay for covered, in-network essential benefits in a plan year. Deductibles, coinsurance, and copayments all count toward that maximum. Premiums do not: the premium is the price of coverage itself and is never counted toward the out-of-pocket cap. Amounts paid for non-covered services and out-of-network charges above the plan's allowed amount also generally do not count. Once the maximum is reached, the plan pays 100 percent of covered in-network costs for the remainder of the year.
Why the other options are wrong
- B) Deductibles count toward the out-of-pocket maximum because they are a form of cost sharing the insured pays for covered services.
- C) Coinsurance is a percentage cost-sharing payment and counts toward the annual out-of-pocket maximum.
- D) Copayments are fixed cost-sharing amounts and count toward the out-of-pocket maximum just like deductibles and coinsurance.
Memory hook
Premiums buy the policy; they never count toward the cap. Deductible, copay, coinsurance do.