Your out-of-pocket maximum is the most money you have to pay for health care in a year, even if you get very sick. This is sometimes called the out-of-pocket limit. Some people think of it like a “worst case scenario.”

Money you spend that counts towards your out-of-pocket maximum includes:

• Health care bills you pay before meeting your deductible

• Copayments

• Coinsurance

After you reach your out-of-pocket maximum, your insurance plan pays 100% of your covered, in-network medical care. You will not have to pay copayments or coinsurance for the rest of the year.

The only health bills you must pay after reaching this amount are:

• Your monthly bill to have health insurance (premium)

• Any care not covered by your plan or care you get out-of-network