The yearly cap on what you pay before insurance covers 100%.
The out-of-pocket maximum is the most you will pay in a plan year for covered, in-network care. Once your deductible, copays, and coinsurance add up to it, the insurer pays 100% of covered services for the rest of the year.
“Out-of-pocket maximum: $8,000 individual.”
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Analyze my document free →It generally excludes premiums, out-of-network care, and non-covered services — so it is not a hard ceiling on every dollar. Track your spending toward it: once met, you should not owe coinsurance on covered in-network care, and bills that still charge you are worth checking.
See this in your own document: run a free analysis — findings quote the exact language.
“You have met your out-of-pocket maximum. Plan pays 100%.”
After this point, covered in-network services should cost you nothing — a bill that still asks for coinsurance is a common error to dispute.