Do PPO members still pay copays after hitting the out-of-pocket max?

Do PPO members still pay copays after hitting the out-of-pocket max?

• A. Yes, they always pay copays after hitting the max
• B. Yes, unless the plan is richer and covers them
• C. No, copays stop after the max is reached
• D. Only coinsurance applies after max

Answer: (B)

Out-of-pocket maximum is the cap you pay for covered services in a plan year. After you hit that cap, cost-sharing for covered services usually stops, but plan designs can vary. The best choice recognizes this variability: copays after reaching the out-of-pocket max can still apply in some plans unless the plan is rich enough to cover those costs entirely. In richer plans, the insurer may pick up more or all costs, including what would have been copays. So, while many plans waive further copays after meeting the max, there are designs where you could still see copays for certain items if the plan isn’t that generous.

Out-of-pocket maximum is the cap you pay for covered services in a plan year. After you hit that cap, cost-sharing for covered services usually stops, but plan designs can vary. The best choice recognizes this variability: copays after reaching the out-of-pocket max can still apply in some plans unless the plan is rich enough to cover those costs entirely. In richer plans, the insurer may pick up more or all costs, including what would have been copays. So, while many plans waive further copays after meeting the max, there are designs where you could still see copays for certain items if the plan isn’t that generous.