What Is an Annual Out-of-Pocket Maximum?

Your annual out-of-pocket maximum is a financial safety net. It's the absolute most you will have to pay for covered services in a plan year. Once you hit this limit, your insurance plan pays 100% of the allowed amount for covered benefits for the rest of the year.

What Counts Toward It

Your payments for deductibles, copayments, and coinsurance all count toward reaching your out-of-pocket maximum. Your monthly premiums do not.

How Mira Mace Can Help

It can be tough to track your spending. Your advocate will review your Explanation of Benefits (EOB) to ensure all eligible costs are being counted correctly toward your maximum, protecting you from overpaying.