She sees her regular doctor and a number of specialists. At the start of her plan year she has an unexpected illness.has a health plan with a $2,500 deductible, 20% coinsurance, and a $4,000 out-of-pocket maximum. Here’s an example of how an out-of-pocket maximum might work, depending on the health plan: It may also include any copays you owe when you visit doctors. This may include costs that go toward your plan deductible and your coinsurance. How does an out-of-pocket maximum work?Ĭosts you pay for covered health care services count toward your out-of-pocket maximum. If you have dependents on your plan, you could have individual out-of-pocket maximums and a family out-of-pocket maximum. A plan year is the 12 months between the date your coverage is effective and the date your coverage ends. Some health insurance plans call this an out-of-pocket limit.
If you meet that limit, your health plan will pay 100% of all covered health care costs for the rest of the plan year. An out-of-pocket maximum is a cap, or limit, on the amount of money you have to pay for covered health care services in a plan year.
