Out-of-Pocket Limit

What is an out-of-pocket limit?

An out-of-pocket limit is the maximum amount healthcare beneficiaries pay for services covered by their plan in a year. Specifically, after individuals pay their copayments, deductibles and coinsurance, their health plan pays all the remaining covered costs. Importantly, health plans will not pay for any out-of-network services.   

Out-of-pocket limits may depend on other health insurance costs, including premiums.  

The out-of-pocket limit depends on the insurer, like Medicare or Medicaid.  

Why are out-of-pocket limits important to healthcare?

Out-of-pocket limits are important to healthcare because they control how much individuals and their families pay for medical care. In turn, limits create more accessible and affordable healthcare options.  

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