The out-of-pocket maximum is the ceiling of what you’d have to pay in a policy year. After that, health insurance covers 100 percent of the medical expenses. This reduces the risk that a medical emergency or serious diagnosis would lead to financial ruin.
Different plans offer different limits. If you don’t see what your out-of-pocket max is when enrolling in a plan, talk to a representative for your health insurance company.
References
Capital District Physicians' Health Plan, Inc. (n.d.). Understanding health insurance terms.
Healthcare.gov. (n.d.). Out-of-pocket maximum/limit.
Glover, L. (2016). Health insurance deductible vs. out-of-pocket maximum. NerdWallet.
MedlinePlus. (2022). How to choose a health plan.
Why trust our experts?
Written by:
Hilary WeissmanHilary Weissman has been a health writer for the past 6 years. She was a senior copywriter at WW (Weight Watchers) before joining GoodRx and was also a copy editor in S&P Global’s structured finance ratings group for 3 years prior.
Reviewed by:
Sanjai Sinha, MDSanjai Sinha, MD, is a board-certified physician with over 20 years of experience. He specializes in internal medicine.
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