5 / 10
Your plan this year
Premium$400 / month
Deductible$2,000
Primary care copay$30
Coinsurance20%
Out-of-pocket max$6,000
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Situation 5 · The bad year
Again starting from zero: a serious illness leads to a hospital stay with allowed charges of $80,000, all in network.
What do you pay?
Correct!
Not quite.
The out-of-pocket maximum is the number that matters, and this is what insurance is for. The usual arithmetic would give $2,000 plus 20 percent of $78,000, or $17,600. The plan stops you at $6,000. After that it pays 100 percent of covered, in-network care for the rest of the plan year. When comparing plans, this is the figure that tells you what a bad year costs.