How Much Is My Out of Pocket Amount?
Your out-of-pocket maximum is the most you’ll have to pay for covered services in a policy period (one year), each January 1st it starts over again, and that includes cost of medications too. After you reach this amount, your health insurance plan will pay 100% for covered benefits called “essential healthcare benefits”. Your out-of-pocket costs are NOT your health insurance premiums. Your monthly premiums are totally separate and are in addition to your medical costs like co-pays, deductibles, and out of pocket maximums.
How Much Do I Pay?
Each plan can have a lower out-of-pocket maximum, these numbers are the worst-case scenario. Check your plans “Summary of Benefits” for details.
2021 Out of Pocket Maximum
The maximum out-of-pocket limit for a health insurance plan for 2021 is $8,550 for an individual plan and $17,100 for a family plan.
2022 Out of Pocket Maximum
In 2022 it is $8,700 for an individual plan and $17,400 for a family plan.
2023 Out of Pocket Maximum
In 2023 it is $9,100 for an individual plan and $18,200 for a family plan.
Think of it like a game of baseball. Once you’ve paid all of your “deductible“, you are standing on 1st base. Now you’ll begin to move towards 2nd base – “Co-Insurance”. During this time, co-insurance is where you and the insurance company split the medical bills (co-insure), for example 70/30 or 80/20. Usually, the insurance company will pay the larger amount and you’ll pay the lesser amount.
Your next step is 3rd base or your “Out of Pocket Maximum”. Once you’ve met your “out of pocket maximum”, you are now done paying anything else. The insurance company will pick you up on 3rd base, and carry you to home plate (they are responsible for unlimited coverage after your out of pocket maximum).
Note: This is an annual accrual, meaning it starts January 1st and ends December 31st each year.
Getting Help with Nevada Insurance Enrollment
It is hard to budget for health expenses when you do not know what your cost-sharing responsibility will be. At Nevada Insurance Enrollment, our health insurance agents can help you review your policy or find reliable health coverage.
Recent Posts
Nevada Driving Laws for Seniors
Studies have shown that advancing age is associated with higher fatal crash rates. As is the case in most states, Nevada has a set of rules for older drivers to ensure their safety and the safety of everyone they share the road with.
How Many Hours Can You Safely Drive?
If you are not accustomed to spending hours per day in your car, it can be difficult to determine how quickly you should aim to reach your destination.
Safety Tips For Driving In The Rain
In Las Vegas, roads are particularly slick at the beginning of the storm. That is because they are built without a drainage layer. Dust, oil and grime collect on the surface of the road. When it rains and these mix with water, the dirt settles to the bottom and the oil rises to the top, creating a very slick surface.
Search This Website
Most Popular Pages
By page visits (this month)
#1) Health Insurance Subsidy Chart
#2) Health Insurance
#3) Health Insurance WITH a Subsidy
#4) Insurance Blog
#5) Request a Quote
Top 5 Most Popular
By page visits (this month)
#1) Health Insurance Subsidy Chart
#2) Health Insurance
#3) Health Insurance WITH a Subsidy
#4) Insurance Blog Posts
#5) Request a Quote
Recent Posts
Healthy Summer Habits To Consider
Whether your summer style is to lounge by the pool and stay in the air conditioning or to take advantage of warm temperatures and sunny skies with cookouts, hikes and camping trips, healthy habits are the key to getting the most of your summer.
American Rescue Plan
The American Rescue Plan Act provided direct relief to working Americans to help the country recover from the economic effects of COVID-19. It included a wide range of benefits for the individuals who met the income qualifications, including direct checks, extended unemployment insurance and support for small businesses.
What To Do: Flat Tire – Engine Won’t Start – Car Overheats
Your car breaks down. Things inevitably just seem to happen, and usually at the worst possible time. A flat tire, your engine won’t start, or your car overheats. Here are a few tips that hopefully, may someday help, if you ever experience a breakdown with your car.
Auto Insurance with a Suspended License
In Nevada, if you accrue a certain number of demerit points within a 12-month period, your license is automatically suspended for six months. If this happens, you may wonder what happens with your auto insurance policy.