Gain a better picture of health insurance expenses by understanding out-of-pocket costs.
Out-of-pocket costs are costs for health care that aren’t reimbursed by insurance companies. Generally, out-of-pocket costs include copays, deductibles, and coinsurance for covered services, as well as expenses for services that aren’t covered by insurance companies.
Watch our video about out-of-pocket costs
Get a clear picture about out-of-pocket costs and limits by watching this video.
Maximum out-of-pocket costs
It’s also important for you to know that there is an annual limitation on all cost-sharing for which patients are responsible under a health insurance plan. This out-of-pocket limit (or out-of-pocket maximum) does not apply to premiums, balance-billed charges from out-of-network health-care providers, or services that are not covered by the plan.
The Affordable Care Act (ACA or “Obamacare”) requires all major medical health insurance plans to have an annual out-of-pocket maximum for each beneficiary of less than $6,350 for 2014 and less than $6,750 for 2015. The ACA also requires all major medical health insurance plans to have an annual out-of-pocket maximum for each family of less than $12,700 in 2014 and less than $12,900 in 2015.