also called out-of-pocket limit
The most you will have to pay yourself in a policy year through deductible, co-pay and co-insurance combined, after which the insurer covers eligible costs in full.
The ceiling on what you personally pay in a policy year once you add up the deductible, co-pays and your share of costs. Hit it, and the insurer covers eligible bills in full from there. It is the number that actually caps your downside, and cheap policies set it sky-high or leave it out entirely. Do not confuse it with the annual benefit limit, which caps what the insurer pays, not what you pay.
Someone picks a bargain policy without checking whether it has an out-of-pocket maximum. A major treatment gets billed with a percentage share owed by them, and because there is no cap on that share, their portion of the bill just keeps climbing with the total.
It is the number that actually caps your risk, and cheaper policies either set it high or do not have one at all. Without a clear out-of-pocket maximum a percentage co-insurance on a major treatment has no ceiling.
Annual benefit limit
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