What does out-of-pocket-max mean?

January 8, 2016

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Lead Copywriter



When you’re scanning the details of your health insurance plan, you might notice the phrase “out-of-pocket-max.”

What does it mean exactly?

Out-of-pocket-max is the MOST you’ll end up paying for your medical bills in a single year.

For example, say you decided that you no longer want to be an investment banker and you want to fulfill your lifelong dream of being a rodeo star. Your rodeo career is going well until your horse bucks you and steps on both of your ankles. You have to get emergency surgery and stay at the hospital for a week. Your medical bill ends up being $45,000, but don’t let that end your cowboy dreams. You won’t have to pay the full $45,000. The most you will pay is your out-of-pocket max, which could range anywhere from $3,000 to $6,850. That includes your deductible amount AND any co-insurance amount you have.

The only time this may not be applicable is if you receive medical service out of your plan network.

So keep at your rodeo goals, cowboy.