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
How to Switch or Cancel Your Auto Insurance Policy
When it comes time to renew your auto insurance, do you simply stay with the insurer that you’ve known and trusted for years? For some, this works out fine. For many, however, this is a costly mistake. If it’s been a while since you’ve shopped around for auto insurance, you could be throwing hundreds of dollars away.
Building the Best Auto Insurance Policy
Your auto insurance needs are unique, and your policy should be also. Knowing the right questions to ask your auto insurance agent as you’re building a policy can help ensure that you get great coverage at a great price.
13 Factors That Affect Your Auto Insurance Price
To determine your premium, your auto insurance company uses a complex algorithm that takes countless factors into consideration. Some of those factors are obviously related to driving, such as how many speeding tickets you’ve had and when you received your last one, the age and type of vehicle you drive, and how many insurance claims you’ve filed in the past.
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
Worries about Full Timers Being Reduced to Part Time
There has been considerable controversy in recent months about whether the Affordable Care Act is causing employers to shift towards a part-time workforce.
Enrolling into a Nevada Health COOP plan?
We HIGHLY recommend you double check that your physician will take the Nevada Health COOP plan you are enrolling into.
Emergency Room Visits Increasing With New Health Law
Those who gained coverage made 40 percent more visits to the emergency room than their uninsured counterparts during their first 18 months with health insurance
President Obama announces Hardship Exemption
Anyone who can show that their individual or family policy has been cancelled, will be eligible to buy a “catastrophic” plan through the Nevada Health Link.