If an out-of-pocket maximum is $3,500, and you get a hospital bill for $10,000, do you only have to pay the $3,500, or the full $10k?
After you meet the deductible and out-of-pocket max, is care essentially “free” the rest of the year since you don’t have to pay out of pocket?
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Just one detail: if the hospital says the bill is for $10,000, the insurance company will say to the hospital “we’ll only reimburse you $6,000…sucks to be you”. But even if you’ve already met your out-of-pocket max for the year, it’s possible the hospital will ask you to pay the remaining $4,000. Whether this “balance bill” is legal depends upon regulations in your state, whether you’re using commercial insurance, and whether your provider was “out-of-network”. If you were “in network” you’ll almost never get a balance bill. Ultimately it really depends on the hospital. For instance, University of Michigan Hospital here in Ann Arbor just basically writes all that stuff off. They don’t bill beyond what is covered by insurance.
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