What is an out-of-pocket maximum for medical insurance?

Question

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?

In: Other

Answer 1

The easiest way to think of this is if you had 20% copay, you’d need to have $17,500 in total covered expenses before everything is free from them on out.

17,500 / 20%= $3500