Glossary
Tags
- ACA
- ACA Marketplace
- ACA subsidies
- CHIP
- CMS
- ESRD
- Extra Help
- FMAP
- FPL
- FQHC
- FSA
- HCBS
- HMO
- HRA
- HSA
- IEP
- IRMAA
- Joint Commision
- KFF
- LCD
- LIS
- Marketplace
- Medicaid
- Medicaid (rare)
- Medicaid expansion
- Medicare
- Medicare Advantage
- Medicare Part A
- Medicare Part B
- Medicare Part D
- Medicare coordination
- Medigap
- NCD
- NEMT
- NOMNC
- Original Medicare
- PCP
- Part A
- Part B
- Part C
- Part D
- QLE
- QMB
- SEP
- SNF
- SNP
- SSI
- Section 1115
- Silver Plan
- Silver plan
Out-of-Pocket Maximum
The maximum amount an individual must pay for covered healthcare services in a plan year before the insurance company covers 100% of the costs. Out-of-pocket maximums apply to ACA Marketplace plans, Medicare Advantage, and some Medicaid programs.
The maximum amount an individual must pay for covered healthcare services in a plan year before the insurance company covers 100% of the costs. Out-of-pocket maximums apply to ACA Marketplace plans, Medicare Advantage, and some Medicaid programs.
Yearly Out-of-Pocket Maximum
The maximum amount an individual must pay for covered services in a calendar year before their health insurance plan covers 100% of additional costs. This applies to ACA Marketplace, Medicare Advantage, and some Medicaid plans. Once the yearly out-of-pocket maximum is reached, the insurer pays all remaining covered expenses.
The maximum amount an individual must pay for covered services in a calendar year before their health insurance plan covers 100% of additional costs. This applies to ACA Marketplace, Medicare Advantage, and some Medicaid plans. Once the yearly out-of-pocket maximum is reached, the insurer pays all remaining covered expenses.