Out-of-Pocket Maximum

The most you pay during a policy period (usually one year) before your health insurance plan begins to pay 100% for covered health benefits. The out-of-pocket maximum includes the yearly deductible and any cost sharing you have after the deductible. The out-of-pocket maximum will differ depending on your insurance company and the insurance coverage you have. Some companies exclude specific costs such as costs incurred for services that are not covered by the policy, or have different maximums for care provided by network and out-of-network providers. If you have a family plan, there may be out-of-pocket maximums for individuals on your plan, as well as your family.


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