Maximum Out-of-Pocket Costs

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Definition - What does Maximum Out-of-Pocket Costs mean?

The maximum out-of-pocket cost is the amount an insured person can spend for health services from their own money over the course of a year.

Once the insured has paid up to their maximum out-of-pocket costs, their insurance company agrees to pay any additional covered expenses within the policy year.

It is also called out-of-pocket limit and out-of-pocket maximum.

Insuranceopedia explains Maximum Out-of-Pocket Costs

For 2018, the maximum is $7,350 for individuals and $14,700 for family plans.

These amounts include deductibles, copayments, and coinsurance paid. It does not include premium costs.

There is usually an inverse relation between premium rates and maximum out-of-pocket costs, meaning that policies with higher premiums tend to have lower out-of-pocket maximums.


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