Real answers for your healthcare questions
What is the difference between a deductible and an out of pocket maximum?
Answer
A deductible is an amount you may need to pay before your plan starts sharing the cost of certain services. The out of pocket maximum is the yearly limit on what you generally pay for covered in network cost sharing before the plan takes over the full covered amount for the rest of the year.
What to Know
You can meet your deductible and still continue paying copays or coinsurance. Those additional payments may continue until your eligible spending reaches the out of pocket maximum. Premiums usually do not count toward either figure.
What to Do Next
When comparing plans, look at both numbers. The deductible helps show when cost sharing begins, while the out of pocket maximum shows your potential ceiling for covered in network medical spending.
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