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Suppose you visit a doctor who is outside the network of doctors, hospitals and other healthcare providers who’ve agreed to accept your insurer’s rates as full payment. The premiums are the price of having healthcare coverage, not a covered healthcare cost.Īlso, your out-of-pocket maximum may apply only to your in-network expenses. After you reach it, your plan will pay for all the other costs of your covered benefits.īut, be aware: Even after you reach your out-of-pocket maximum, you’ll still have to pay your premiums, the amount you pay every month for your healthcare coverage (in many cases, with the help of your employer). But, if one year you have a lot of healthcare expenses, you may reach it-and will be glad it’s there. If you’re generally in good health, you may never reach your out-of-pocket maximum.
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And, it might include coinsurance, a percentage of the cost of healthcare services. It might include copays, the fixed amounts you have to pay for healthcare services.
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That might include a deductible-how much you have to spend in a year before your health plan begins covering your medical costs. To reach your out-of-pocket maximum, you’d pay all the costs your health plan requires you to pay. If you have a health plan, what is your out-of-pocket maximum? That’s the highest amount you’d have to pay for covered health services in a plan year. Reaching Your Out-of-Pocket Maximum January 25, 2018