Out-of-pocket costs, sometimes called OOP

There are often out-of-pocket costs you must pay when you use health care services, even when you have insurance, such as a visit to the doctor or medication. Here are some fees that add up to your total out-of-pocket costs:

  • Copays
  • Deductibles
  • Coinsurance
  • Out-of-network payments

There are limits on how much of these costs you have to pay. Once you hit this limit, called the out-of-pocket maximum, your plan will pay 100% for covered benefits. The out-of-pocket maximum does not include your monthly premiums

The out-of-pocket maximum will vary each year. With the exception of grandfathered policies, all health plans, including those offering only catastrophic coverage, must limit out-of-pocket spending to $8,150 for an individual and $16,300 for a family in 2021.

WebMD Medical Reference Reviewed by Sarah Goodell on June 21, 2021
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