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Deductible vs. out-of-pocket maximum

What happens after the out-of-pocket maximum is met?

Out-of-Pocket Maximum

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.

Deductible vs. out-of-pocket maximum 

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.

What happens after the out-of-pocket maximum is met?

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.

This material has been prepared for informational purposes only, and is not intended to provide, and should not be relied on for, legal or tax advice. If you have any legal or tax questions regarding this content or related issues, then you should consult with your professional legal or tax advisor.
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