What Does Health Insurance Out Pocket Maximum Mean?

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One response to “What Does Health Insurance Out Pocket Maximum Mean?”

1. 

   March 12, 2013

   Bob Vineyard

   Your OOP (out of pocket) limit is a moving target and can be a misnomer.

   Usually it means the maximum amount you may be required to pay during a calendar (or plan) year but that can be misleading.

   Your OOP almost always includes the deductible and coinsurance but does not include any copay’s for Rx or doctor visits. If you have OON (out of network) charges from non-par providers you OOP can be considerably higher, including a separate OON deductible, higher coinsurance and higher OOP for non-par providers.