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

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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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13 Answers

Anonymous 0 Comments

Can’t read all prior posts, just wanted to mention 1. Be sure you know what the start and end date of your year is- some are not Jan-Dec. also, there is a Lifetime maximum as well. Keep an eye on it too. Lifetime max is a point at which you max out your coverage.

Anonymous 0 Comments

Basically yes, if you meet your deductible, anything else that is covered is free. For example, last year I had surgery on January 10, and that definitely met my deductible, so all other appointments and prescriptions for me and my spouse for the rest of the year were free.

Anonymous 0 Comments

Had a quadruple bypass in the UK. Parking was £5 per day and had to pay another £5 per day for the TV. Had to pay each day. No other charges.