Out-of-pocket medical expenses not covered by insurance, including deductibles, coinsurance, copayments, and any services that are not eligible under an insurance plan. In other words, these expenses will be paid straight “out of your pocket” using your own personal funds.
An out-of-pocket maximum is a limit set on the total amount of money you are responsible for spending out-of-pocket yearly on deductibles, coinsurance, and copays combined. Once you reach this maximum amount, you no longer have to spend money on covered services– your health insurer will cover 100% of costs. Monthly premiums do not count towards your out-of-pocket maximum, nor does your spending on services not included in your health plan.