Covered California Certified Enroller Practice Exam

What must members pay until out-of-pocket maximum is met under the Catastrophic plan?

1. 100% of the cost

2. Co-payments

3. 50% of the cost

4. Nothing

The correct answer is: 100% of the cost

Under the Catastrophic plan, members are required to pay 100% of the cost of their healthcare services until they reach their out-of-pocket maximum. This requirement is designed to keep premiums lower, as Catastrophic plans are aimed at young adults and those who generally do not anticipate needing extensive medical care. The structure encourages individuals to have a financial safety net while still placing a significant cost on the individual prior to reaching the out-of-pocket limit. Once that maximum is reached, the plan typically covers 100% of the costs for essential health benefits. The other options involve concepts that do not apply to the Catastrophic plan's cost-sharing structure before reaching the out-of-pocket maximum. For instance, co-payments and percentages of costs represent scenarios more common in other types of health plans, such as Silver or Gold plans, which provide a different balance of costs and coverage.