What is the out of pocket max? What happens when I reach the max? Do I have to do anything?

An out of pocket max is the most amount of money you will have to pay through a policy period. The out of pocket max includes the money you pay in deductible, copay, and coinsurance. After you hit the out of pocket max, the insurance company will pay 100% of all covered services.

For example, the out of pocket max for any individual plan through the Marketplace is $6,600 and $13,200 for group plans for 2015. If you have an individual plan through the Marketplace, after you hit $6,600 dollars in out of pocket payments (from deductible, copay, and coinsurance) your plan will start paying for 100% of all covered services.

Then you can basically have medical care for free until your plan renews or you get another plan. The deadline is usually December 31 of the current year.

Andy Lambert

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