9 / 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 9 · Keeping track
By September you have paid $4,000 in premiums, the $2,000 deductible, $300 in copays and $900 in coinsurance.
How much has counted toward your $6,000 out-of-pocket maximum?
Correct!
Not quite.
The out-of-pocket maximum counts what you pay for covered, in-network care: the deductible, copays and coinsurance. Here that is $2,000 plus $300 plus $900, or $3,200. Premiums never count. Neither do services the plan does not cover, or amounts an out-of-network provider bills above the plan’s allowed price. You have $2,800 to go before the plan pays everything.
More: Your Health Insurance Has a Spending Limit. But What Does It Actually Protect You From?