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
deductible
The amount your health insurance plan requires you to pay for health care services and supplies before they begin to pay. For example, if your deductible is $1,500, you are responsible for paying for all of the services and supplies you receive (except for any covered preventive services) until the amount you paid reaches $1,500. Once the deductible has been reached, your insurance company may pay for all of your health care expenses, or you may have to pay co-insurance, a percentage of the charges. If you have a high deductible health plan, you may be eligible for a Health Savings Account.
and any cost sharing you have after the
deductible
deductible
The amount your health insurance plan requires you to pay for health care services and supplies before they begin to pay. For example, if your deductible is $1,500, you are responsible for paying for all of the services and supplies you receive (except for any covered preventive services) until the amount you paid reaches $1,500. Once the deductible has been reached, your insurance company may pay for all of your health care expenses, or you may have to pay co-insurance, a percentage of the charges. If you have a high deductible health plan, you may be eligible for a Health Savings Account.
. The out-of-pocket maximum
deductible
deductible
The amount your health insurance plan requires you to pay for health care services and supplies before they begin to pay. For example, if your deductible is $1,500, you are responsible for paying for all of the services and supplies you receive (except for any covered preventive services) until the amount you paid reaches $1,500. Once the deductible has been reached, your insurance company may pay for all of your health care expenses, or you may have to pay co-insurance, a percentage of the charges. If you have a high deductible health plan, you may be eligible for a Health Savings Account.
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
out-of-network
A facility, health care provider and supplier that does not have a contract with your health insurance plan to provide care to you. You will pay more for health care services received out-of-network than services received in-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.