Medical Expense✓ Verified · outline & fact-checked · Sep 2026Difficulty 2/5
Which expense 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 caps the insured's share of covered medical costs, including deductibles, copayments, and coinsurance, during the policy year. Premiums are never counted toward that limit because they are the price of maintaining coverage itself, not a cost of receiving care. Under the contract-terms material in AH-III.A.1d, distinguishing what is and is not included in the out-of-pocket maximum is a standard exam question because it requires understanding that cost-sharing, not premiums, is capped.
Why the other options are wrong
- B) Deductibles are a form of cost-sharing and do count toward the out-of-pocket maximum.
- C) Copayments are fixed cost-sharing amounts for services and count toward the limit.
- D) Coinsurance is a percentage cost-sharing obligation and also counts toward the out-of-pocket maximum.
Memory hook
Premiums pay for the policy; only cost-sharing chips away at the OOP cap.