Product Learn Centers
Find The Best Insurance
We make it easy to compare and buy insurance.LEARN MORE
Understanding the difference between your health insurance out of pocket expenses and your policy's deductible.
In a health insurance plan, the deductible is the amount of money you need to pay out-of-pocket before your health insurance starts covering health care services. The out-of-pocket limit, on the other hand, is the maximum amount you'll spend out of pocket in a given calendar year.
Once you meet your deductible, you typically split costs with your health insurance company using either a copay or a coinsurance percentage. The money you spend on copayments or coinsurance count towards your out-pocket-limit, as does your deductible. Monthly premiums do not count towards your deductible or your out-of-pocket limit.
Once you meet your out-of-pocket limit, your health insurance company will pay for 100% of your health care services. You will still need to pay your monthly premium.
Health insurance plans with lower monthly premiums tend to have higher deductibles and higher out-of-pocket limits and vice versa. There is a federal maximum out-of-pocket limit. For 2019, the maximum limit is $7,900 for individual plans and $15,800 for family plans.
Some plans, known as catastrophic health insurance plans, have a deductible that is the same as the out-of-pocket limit. These plans are only available to people under 30 and people with a hardship exemption. Catastrophic plans are designed to cover you in the event of very expensive accidents or if you are diagnosed with a medical condition that requires a lot of care.
Policygenius’ editorial content is not written by an insurance agent. It’s intended for informational purposes and should not be considered legal or financial advice. Consult a professional to learn what financial products are right for you.
Security you can trust
Yes, we have to include some legalese down here. Read it larger on our legal page. Policygenius Inc. (“Policygenius”) is a licensed independent insurance broker. Policygenius does not underwrite any insurance policy described on this website. The information provided on this site has been developed by Policygenius for general informational and educational purposes. We do our best efforts to ensure that this information is up-to-date and accurate. Any insurance policy premium quotes or ranges displayed are non-binding. The final insurance policy premium for any policy is determined by the underwriting insurance company following application. Savings are estimated by comparing the highest and lowest price for a shopper in a given health class. For example: for a 30-year old non-smoker male in South Carolina with excellent health and a preferred plus health class, comparing quotes for a $500,000, 20-year term life policy, the price difference between the lowest and highest quotes is 60%. For that same shopper in New York, the price difference is 40%. Rates are subject to change and are valid as of 2/17/17.
Copyright Policygenius © 2014-2019