Out Of Pocket Maximums: Don't Miss Out On Thousands This Year
What Is An Out-Of-Pocket Maximum?
An out of pocket maximum is an insurance term that refers to the most you will have to pay for covered services within a plan year (most insurance plans run on the traditional calendar year, but this can vary.) You may also hear it called an out of pocket limit as well and can be used interchangeably. Once this amount has been reached, your insurance will pick up the tab for 100% of any covered medical services.
A person's monthly premiums are not included in the out of pocket maximum. However, co-pays, deductibles, and co-insurance are typically counted towards the maximum. If you're not sure what is covered under yours, check with your specific insurance provider to better understand the conditions of your plan.
How To Take Advantage Of Your Out-Of-Pocket Maximum This Year:
The first thing people should try to do is call their insurance company and clarify the terms and conditions of their plan. Then find out how close they are to reaching their limit. A good time to do this is around October. This will give you enough time to plan your next steps.
If you've hit your maximum for the year, it may be the perfect time to seek medical care for an issue that's been bothering you. Maybe you've had recurring shoulder pain that requires a specialist, but you've been worried about the bill. Or perhaps you need to see a foot/ankle doctor, but weren't sure how much it would cost. Get on the phone with the right specialist and plan out a timeline for receiving treatment before your limit resets. When you contact these clinics, make sure you let them know your situation and that you're working with a timeline that resets at the end of the year. Many providers will do what they can to help. Our specialists work overtime and are always trying to accommodate these patients at the end of the year and most good providers do the same.
Many of our patients come to us to get their varicose veins treated after they have hit their out of pocket limit for the year. Typically, they are responsible for zero of the expenses and are now enjoying pain-free beautiful legs again.
Education Is Key
It pays to take a look at your health insurance plan and learn how it works.
As mentioned before, we help a lot of Alaskan's with their vein disease every year. Unfortunately, some of these patients had no idea how their medical insurance was structured. They needed treatment years ago, but weren't aware that they could have it covered for free.
There have also been situations when patients were treated assuming they would need to pay all or part of the bill only to find out that the entire procedure was covered. This is great news, but there's a lot of opportunity being left on the table each year when folks are unaware of just exactly how much healthcare they're entitled to.
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