Health Insurance

What does out-of-pocket maximum mean?

A Answers (2)

  • A , 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.

    1 person found this helpful.
  • 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. Deductibles, co-insurance amounts and co-payments will count toward your out-of-pocket maximum.
    2 people found this helpful.
Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.
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