Out-of-pocket health care costs are exactly what the name says: money you pay on your own, from your own pocket for costs that are not covered by your health insurance plan. Out-of-pocket expenses include deductibles, coinsurance, and copays for covered services and any health care services that aren't covered by your plan. Your out-of-pocket limit, or out-of-pocket maximum, is the most money you will pay for covered services during one plan year or calendar year. Once you meet that limit, your health insurance company will pay for any other covered expenses allowed under your plan for the rest of the year. There are things the out-of-pocket limit does not include, such as: Your monthly premium (or, the amount you pay each month to keep your health insurance); Services your plan does not cover; Visits to providers or facilities that are not part of your network; Certain prescription drug expenses; And costs that a provider may charge above
the amount that's allowed for that service. Each health insurance company sets its own
out-of-pocket limits. Depending on the terms of your plan, you might have an individual maximum and a family maximum. Plans with low out-of-pocket limits often have higher premiums... and plans with higher out-of-pocket limits often have lower premiums. Check with your health plan to learn what your out-of-pocket maximum is and what does–and does not–count toward your limit.
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YT17084
