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How do out-of-pocket maximums work?

Who is this for?

Michigan Health Insurance – Customer Service – Learn More

This information will help you if you're shopping for health insurance and have questions about how it works and how your money is spent.

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. 

Your deductible, coinsurance and copays for all medical and drug expenses go towards your out-of-pocket maximum.

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