Out-of-pocket maximum is the most you have to pay for covered health services in a plan year. After you spend this amount on deductibles, copayments, and coinsurance for in-network careIn-network care is when a health provider has a signed agreement with your health insurance company to provide care for plan members at a certain rate and services, your health plan will pay 100% of the cost of covered benefits.
The out-of-pocket limit doesn't include:
- Your monthly premiums
- Anything you spend for services your plan doesn't cover
- Out-of-network care and services
- Costs above the allowed amount for a service that a provider may charge