What does out of pocket mean in medical insurance?

Answer 1

The annual out of pocket maximum refers to the actual amount of money you will pay for your medical cost before an insurance plan pays 100% of your bill. For example, if you have an "80/20" plan with a deductible of $2000.00 and a maximum out of pocket of $5000.00, you would be responsible for paying the first $2000.00 of the hospital bill, then the insurance company would pay 80% of the bill and you would pay 20% of the bill. Now, you've already paid $2000.00 so you have $3000.00 of your max out of pocket to pay. Once your 20% of paying that bill reaches the balance of that $3000.00, you would have paid your maximum out of pocket total of $5000.00 and the plan would then pay the remainder of the bill 100%.