[Health Insurance] What is the difference between "deductible" and "maximum out-of-pocket expense limit"?
your deductible is the amount you have to pay during one year before your insurance company will start paying their portion of the bill. maximum out-of-pocket expense is the most $ you will have to pay during one year. i'll give you a hospital-related example: your insurance requires a $750 deductible and pays 80% of your bill after the deductible is met. your maximum out-of-pocket expense is $2000. let's say you have a blocked artery in your heart that requires a stint, and the estimated bill is gonna be $10,750. 1st you pay your $750 deductible. normally, insurance would now pay 80% of the bill leaving you with $2000 to pay. but since you have a $2000 maximum out-of-pocket expense, you will only pay $1250 of that portion (since you have already paid $750). as long as any proceeding medical problems are covered by your insurance, you will not have to pay anything for the rest of this year of coverage.
by solodadd - a day ago
This Site Might Help You. RE: [Health Insurance] What is the difference between "deductible" and "maximum out-of-pocket expense limit"? [Health Insurance] I dont exactly understand how both the terms apply to my expenses towards a medical care. I am talking about Physican and Hospital Services in particular, rather than Preventive Care.
by Kari - a day ago
deductible is how much you have to pay, before the insurance kicks in. AFTER you've paid out your whole deductible, usually you keep paying 20% of the bill . . .sort of a co-pay, until you reach a set amount, the "max out of pocket". Then the insurance pays 100% until the limits run out. Example, $500 deductible, Max OOP $2500 . . . you pay the first $500, Then you have another $100,000 of bills. On the first $10,000, you pay your 20% copay, but now you've paid out $2500 total, so you don't pay out the 20% any more.
by mbrcatz - a day ago
Deductible and out-of-pocket expense (aka co-insurance) are similar in that they are money that you have to pay first before the insurance kicks in.
by floozy_niki - a day ago
Deductable is what you'll pay up front. Maximum out of pocket is supposed to be the most you'll pay from your pocket in a calander year. There are always strings attached.
by cadee884 - a day ago
Ask your HR, they will know.
by ? - a day ago
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