Difference between revisions of "Out-of-pocket"
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Revision as of 07:48, 15 February 2017
What is out-of-pocket?
Out-of-pocket or OOP is the amount of the health plan member pays for covered services, typically in a year.
Out-of-pocket expenses usually include deductibles, co-insurance, co-payments, pharmacy costs, and any additional costs due to lab visits.
Healthplans will usually define the out-of-pocket maximum or out-of-pocket limit which is the most a health plan member will have to pay for covered services in a plan year. After spending this amount on deductibles, copayments, and coinsurance, the health plan pays 100% of the costs of covered benefits.
