out-of-pocket max
Insurance payment limit
Out-of-pocket max is the maximum amount you pay for covered healthcare in a plan year before insurance covers 100% of costs.
Once you hit this ceiling through deductibles, copays, and coinsurance, the insurer pays everything else.
After my surgery pushed me past my out-of-pocket max, the rest of the year's care was free.
Also called out-of-pocket maximum.
- high deductibleSteep initial self-payment
- cost sharingSplitting payment obligations
- coverageExtent of inclusion
- family coverageInsurance for relatives together
- insuranceContractual risk coverage
health plan · medical · medical bills · expenses · limit · threshold · cap · healthcare · policy · benefits · annual · open enrollment · catastrophic · network · claims · billing · hospital · pharmacy
cost-sharing structure
out-of-pocket maxdeductible
Out-of-pocket threshold amount
copay · coinsurance · premium
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