MA plans with an out-of-network component may or may not have what for OON services?

In Medicare Advantage (MA) plans that include an out-of-network (OON) component, the presence of an out-of-pocket (OOP) maximum is a crucial feature. The OOP maximum represents the total amount a member would have to pay for covered services in a plan year. Having an OOP maximum provides financial protection for members, ensuring that they won't face unlimited expenses when using OON services, which can sometimes be more costly.

While not every MA plan with an OON component is required to have an OOP maximum for OON services, many plans do choose to incorporate one to attract members by offering greater cost protections. This aspect is particularly important as it helps to mitigate the financial risks associated with receiving care from providers that are not within the plan’s network. Thus, for members considering the potential costs associated with using OON services, the existence of an OOP maximum is a key factor in evaluating their options and understanding what their financial liabilities might be.

Other answer choices, such as premium adjustments, referral requirements, and specialist networks, do not directly address the core function of protecting members from excessive out-of-pocket costs like the OOP maximum does. These factors might vary based on the specific plan structure but do not inherently provide the