How Do Out-Of-Pocket Maximums Work?
You share the cost of your care with your health insurance company when you pay your deductible, coinsurance and copays. But did you know there’s a limit to how much you pay? It’s called an out-of-pocket max, or maximum.
It’s the most you’ll have to pay during a policy period, usually a year, for health care services.
What you pay toward your plan’s deductible, coinsurance and copays are all applied to your out-of-pocket max.
Once you reach your out-of-pocket max, your plan pays 100% of the allowed amount for covered services.
If your plan covers more than one person, you may have a family out-of-pocket max and individual out-of-pocket maximums. That means:
Out-of-pocket maximums for dental plans also limit what you pay in deductible, coinsurance and copays. But dental plans usually only have an out-of-pocket max for members age 19 and younger.