Out-of-Pocket Maximums & Copayments -The Basics

Your Annual Out-of-Pocket Maximum – The Maximum Amount You Will Pay Each Year

Your annual out-of-pocket maximum is the absolute maximum amount of money you will pay for covered services during a year. One you reach your annual out-of-pocket
maximum, your health insurance plan covers your medical costs at 100 percent.

Your Copayment- The Cost of a Doctor Visit or Pharmacy Item

Your co-payments (or copays) are set dollar amounts you to your medical providers for specific covered services. The most common types of copay’s are doctors
visit copays and pharmacy copays. For example, you may make a $30 copay for  each covered visit to your pharmacy copays. For example, you may make a $30 copay
for each covered visit to your primary care provider. Often, copay are capped at
a certain number of uses per year.