Final answer:
After reaching the maximum OOP expenses in a MAP, the member has no further cost-sharing obligations for covered services for that year, as documented in studies which show how cost sharing reduces healthcare usage without affecting health outcomes.
Step-by-step explanation:
Once a member with a MAP (Medicare Advantage Plan) reaches the maximum Out-of-Pocket (OOP) expenses, they are not responsible for cost-sharing for any additional covered services within that plan year.
Health insurance plans, including MAPs, typically have cost-sharing mechanisms such as deductibles, copayments, and coinsurance; these are meant to mitigate moral hazard by ensuring that members have a financial stake in their healthcare utilization. Studies have shown that cost sharing can lead to a significant reduction in medical care consumption without a discernible difference in health status.
However, once the OOP limit is reached, the insurance provider covers the costs of services completely for the rest of the plan year, thereby eliminating further cost-sharing for the member.