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.
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.