Maximum Out-of-Pocket Costs

What Does Maximum Out-of-Pocket Costs Mean?

The maximum out-of-pocket cost is the highest amount an insured person is required to spend for healthcare services from their own funds over the course of a year.

Once the insured has reached their maximum out-of-pocket costs, the insurance company will cover any additional eligible expenses for the remainder of the policy year.

It is also referred to as the out-of-pocket limit or out-of-pocket maximum.

Insuranceopedia Explains Maximum Out-of-Pocket Costs

For 2018, the maximum out-of-pocket cost is $7,350 for individuals and $14,700 for family plans.

These amounts include deductibles, copayments, and coinsurance, but do not cover premium costs.

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