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Many (most? I always take employer-sponsored, not an expert on all plans) health insurance plans in the US have a concept of out-of-pocket max. This is a yearly amount that is essentially your maximum yearly liability. That amount can vary from plan to plan and year to year. Usually a lower out of pocket max means higher premiums, similar to the idea of having a lower car insurance deductible usually means higher premiums.

It looks like all plans sold through the healthcare.gov marketplace is required to have out of pocket maximums.

https://www.healthcare.gov/glossary/out-of-pocket-maximum-li...




Thanks for answering - one last question!

Is that a hard limit and you'll never have to pay more than that?


Trick question... - Some policies have a cap on benefits. So, your max out-of-pocket might be $10,000/person, but there's also a max benefit of $2,000,000 (made up numbers). This type of plan language was mostly banned with the ACA (Obamacare), but there are some grandfathered plans.

- Balance billing - there is no guarantee that the insurance provider will actually pay what the hospital bills. Insurance companies usually have negotiated rates with some providers. So, if you end up at an ER that's out of network (no negotiated rates), your insurance might pay what they think is reasonable and the hospital bills you the excess. Several California-based hospitals are notorious for this. It also happens with helicopter ambulance transport - frequently, they'll bill $50,000 for a ride, insurance covers $25,000, and the patient is stuck with a $25,000 balance (again, made up numbers).


Though the practice is now largely prohibited, there are instances where insurers will have caps on how much they will pay out, either over a lifetime or within a year.

So it is not an absolutely hard limit in all cases, no.

Edit: originally wrote year twice.




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