How do out-of-pocket maximums work?

When you’re choosing a health insurance plan, it’s good to know how it will fit into your budget. The out-of-pocket maximum for your plan is an important factor to consider.

An out-of-pocket maximum is the most you will have to pay during a policy period (usually a year) for health care services you receive. Once you have reached your out-of-pocket maximum, your health insurance plan begins to pay 100 percent of the allowed amount.

What counts toward the out-of-pocket maximum?

Your out-of-pocket maximum doesn’t include your premium or charges for health care services your health insurance plan doesn’t cover. 

It’s always a good idea to check the details of your particular health insurance plan to see what’s included in your out-of-pocket maximum. Some plans don’t count all of your copays, deductibles, coinsurance payments, out-of-network payments or other expenses toward this limit.