Aug 12, 2020

stethoscope, phone, OOP

Understanding the Out-Of-Pocket Costs of Health Insurance

Ever wonder why your medical bill was higher than expected? Health insurance is expensive, so it is important to know what is covered by your health insurance plan. Out-of-pocket (OOP) expenses are expenses for services that you are responsible to pay on your own that are not covered by your health plan.

Depending how your health plan is set up, certain health care expenses count towards an OOP annual maximum. These expenses include deductibles, coinsurance, copays, prescription drugs, supplemental health insurance or other services in the plans contract. Taking your deductible, for example, some plans are set up where the costs that you pay out of your own pocket will go towards your deductible. The same goes for coinsurance. Your health plan will share costs with you once your deductible is met.

There are health expenses that do not count towards your OOP maximum because they are not covered by your plan. These costs include, but are not limited to, your premium, alternative medicine, cosmetic treatments and vitamins. You also must keep in mind the OOP works differently for an individual or family coverage. It is recommended to review your health plan for expenses covered, especially if you are having a procedure of a higher cost.

Health plans can be confusing. If you have questions about how your plan works, reach out to your health insurance broker for assistance so you don’t have unexpected financial surprises.

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