Skip to main content

Out-of-Pocket Maximums, Copay, and Coinsurance

You mentioned out-of-pocket maximum, what does that mean?

In the examples we used, we mentioned the term out-of-pocket maximum. An out-of-pocket maximum is the annual limit on the amount of money that you would have to pay for health care services, not including monthly premiums. After the maximum is reached, all covered health services are paid in full by the health plan for the rest of that plan year. 

infographic deductible plus copays plus coinsurance equals out-of-pocket max

It's important to note that all payments that apply to the deductible also apply to the out-of-pocket maximum.

Copay vs. Coinsurance, what's the difference?

We also mentioned the terms copay and coinsurance. The graphics below help you to understand the difference. 

copay infographic fixed dollar amount you pay after deductible is met for some covered services copay amounts can vary by plan health care service and type of doctor you see
coinsurance infographic percentage of a medical charge that you pay for healthcare received after you meet your deductible