Deductible vs. out-of-pocket maximum
What happens after the out-of-pocket maximum is met?
An out-of-pocket maximum refers to the maximum an individual has to pay for covered medical expenses before the insurance company begins to fully cover medical expenses for the rest of the plan year.
The main distinction between a deductible and an out-of-pocket maximum is how much the insurance company covers after the required maximum is met. A deductible is the amount an individual has to pay for covered services before their insurance begins to partially cover medical services. For a deductible, after you reach the cap on your deductible your insurance only partially covers the cost of covered services.
With an out-of-pocket maximum, your insurance covers the full cost of covered services after reaching the cap. Out-of-pocket maximums tend to be set higher than deductibles for this reason.
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