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[Health Insurance] 10, Out-of-Pocket Maximum and Stop-Loss Provisions
Published 3 weeks, 2 days ago
Description
This podcast is made by Ran Chen, who holds an EA license, Insurance and Securities licenses (Series 6, 63, 65), and the CFP® designation. He is passionate about opening access to high-quality exam preparation resources and helping learners prepare more effectively for professional certification exams.
In this episode you will learn:
- The out-of-pocket maximum is the absolute most an insured will pay for covered, in-network services in a policy year.
- Once the out-of-pocket limit is reached, the insurance company pays 100% of all subsequent covered costs.
- Deductibles, coinsurance, and copayments for covered services are the three costs that count toward meeting the maximum.
- A critical exam trap is knowing what does NOT count: monthly premiums, non-covered services, and out-of-network charges.
- The terms "out-of-pocket maximum" and "stop-loss provision" are often used interchangeably on the exam to refer to the insured's spending cap.
For more free exam prep tools, practice questions, and AI-powered explanations, visit https://open-exam-prep.com/ or YouTube Channel: https://www.youtube.com/@Open-exam-prep