National Center for Competency Testing (NCCT) Medical Assistant Practice Test

The amount an insured patient must pay towards claims before insurance covers medical treatment is known as what?

1. Premium

2. Out-of-pocket maximum

3. Deductible

4. Co-payment

The correct answer is: Deductible

The amount an insured patient must pay towards claims before insurance begins to cover medical treatment is known as a deductible. A deductible is a specific dollar amount that individuals need to pay out-of-pocket for healthcare services before their health insurance starts to pay its share. For instance, if a patient has a deductible of $1,000, they will need to pay for the first $1,000 of their medical expenses themselves. After the deductible is met, the insurance company typically covers a portion of the costs, and the patient may still have some costs to cover, such as co-payments or coinsurance. The other terms mentioned relate to different aspects of health insurance. A premium is the amount paid for a health insurance policy, often on a monthly basis, independent of the claims made. An out-of-pocket maximum is the maximum amount a patient will have to pay for covered services in a plan year; once reached, the insurance covers 100% of additional costs. A co-payment is a fixed amount that a patient pays for specific medical services or prescriptions at the time of receiving care, which is separate from the deductible. Understanding these terms is essential for navigating health insurance and managing medical expenses effectively.