What counts toward the Out-of-Pocket Maximum for a Medicare Advantage plan?

The out-of-pocket maximum for a Medicare Advantage plan is designed to protect members by capping the amount they have to spend on covered healthcare services and prescription drugs in a given year. Therefore, the correct answer encompasses all out-of-pocket costs associated with both healthcare services, such as doctor visits and hospital stays, as well as prescription medications. This means that any deductibles, copayments, and coinsurance that are paid by the member for these covered services contribute to reaching the out-of-pocket maximum.

Other options do not reflect the total costs that count towards this maximum. While hospital stay expenses are indeed part of the healthcare costs, they do not encompass the full scope of out-of-pocket expenses, thus limiting the coverage of that choice. Premium payments are not included in the out-of-pocket maximum calculation, as these are considered regular payments for maintaining coverage rather than costs incurred during the actual utilization of services. Similarly, services not covered by Medicare do not factor into the out-of-pocket maximum because they are not typically eligible for benefits under the plan, meaning members would pay those costs entirely out of pocket without any limit imposed by the out-of-pocket maximum.