Health Insurance

What does out-of-pocket maximum mean?

A Answers (2)

  • AMichael Roizen, MD, Internal Medicine, answered

    Your out-of-pocket maximum is the predetermined amount of moolah you’ve got to spend in a year before your insurance kicks into high gear and starts covering the FULL cost of all of your medical care. Depending on your plan, you may have an out-of-pocket maximum for prescriptions that’s separate from other medical care, like a visit to your doctor.

    Your co-pays, deductible, co-insurance, and other out-of-pocket expenses all tally up to meet your out of pocket max.

    Review your Summary Plan Description (SPD) to see what counts towards your max and what your max actually is. If you start dozing just thinking about your SPD, you can also contact your benefits office or insurer directly.

    Helpful? 1 person found this helpful.
  • AUnitedHealthcare answered

    An out-of-pocket maximum is the most you have to pay in deductibles and co-insurance for covered health services during a plan year. Depending on your plan design, the out-of-pocket maximum may also include co-payment amounts. Review your plan documents for specific details on your plan’s out-of-pocket maximum.

    Helpful? 2 people found this helpful.
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