Every health insurance plan has an out-of-pocket maximum. An out-of-pocket max is a cap, or limit, on the amount of money you have to pay for covered health care services in your plan’s year. Once you reach your out-of-pocket max, your plan pays 100% of all covered health care costs for the rest of the plan year. What you pay towards your plan’s deductible, coinsurance and copays are all applied to your out-of-pocket max.
If you have dependents on your plan, you could have individual out-of-pocket maximums and a family out-of-pocket maximum. This depends on the terms of the plan.
- When the deductible, coinsurance, and copays for one person reach the individual maximum, your plan then pays 100% of the allowed amount for that person.
- When what you’ve paid toward individual maximums adds up to your family out-of-pocket max, your plan will pay 100% of the allowed amount for health care services for everyone on the plan.
What doesn’t go towards your out-of-pocket max is the amounts you pay for health care services that aren’t included in your plan’s benefits and your monthly premium.
Cosmo Insurance Agency is a full-service independent insurance agency based in Hackensack (Bergen County) and Lakewood (Ocean County), New Jersey that offers an all-encompassing range of insurance options for both individuals and businesses. Cosmo keeps its promise to assure an efficient and creative approach to the services we offer. Each of our clients experience a personalized and long-term relationship with us. Our New Jersey based team of health brokers guides our clients in helping them choose the most cost-effective options. By incorporating our knowledge of the insurance guidelines for healthcare, employee benefits, life insurance, self-insurance, dental, disability, and long term care insurance, we keep our clients up-to-date with affordable plans that cover all their specific insurance needs.