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
Two of the Most Naïve and Aggravating Things Insurance Agents Hear
Many people don’t recognize the value of life insurance and health insurance until they actually use it and may even think they can work around high medical or funeral expenses.
Exchanging Insurance Information After an Accident
Unfortunately, failing to collect the other driver’s personal information and provide them with your own can delay the claims process. On top of that, in Nevada, leaving the scene of an accident without providing personal information is technically a hit and run, which could result in criminal charges.
Does Lying To Your Auto Insurance Company Get You A Better Rate?
Your auto insurance premium is based on a variety of factors, your personal info may cause you to pay more or less for your coverage than your neighbor pays. The application process for auto insurance can be complicated, and not verifying important information or even deliberately lying can have serious consequences.
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
New contractor hired to fix Nevada Health Link problems
There is now a new Contractor hired to fix Nevada Health Link’s website prior to next year’s “Open Enrollment”.
Health Insurance plan Unaffordable? Need Exemption?
When individuals and families buy their own health insurance, IF the insurance is greater than 8% of your “household income”, it is considered “unaffordable” and you are not required to buy health insurance.
Health Insurance “OFF” the Exchange with NO waiting period
A new health insurance company called the Nevada Health CO-OP is allowing “OFF Exchange Enrollments” with no waiting period.
Nevada Health Link On Pace To Be At 21% of Target Enrollment
The exchange is enrolling as many as 1,000 customers a week; at that pace, sign-ups could max out at around 25,000 on March 31 (Deadline).