How to Determine an Out-of-Pocket Health Expense Limit You're Comfortable With

The expression 'affordable healthcare' is thrown around a lot. However, the reality is that for the most part, any kind of healthcare you receive will not be entirely free. There will still be expenses that you'll have to cover on your own, and these may include monthly premiums, deductibles, and pharmacy dispensing fees.

Basically, anything that is left after Medicare has covered its part and isn't covered by your other insurance coverage will become an out-of-pocket expense. It's also important to note that there are services and procedures that will not be covered by Medicare at all.

Understand Out-of-Pocket Limit

The out-of-pocket expense is an amount that the patient has to pay to receive a medical service. This amount isn't covered by your insurer or by Medicare and you are not reimbursed for the payment. The out-of-pocket limit is the maximum amount of money you can pay towards receiving health services in a particular year. In case your medical bills exceed this limit, they will be taken care of by your insurance provider.

However, not all the money that you'll pay towards receiving a health service will contribute to this maximum. For example, a co-payment that isn't subject to the deductible will not count towards this maximum.

Choosing the Right Limit

In many insurance policies, you'll find out-of-pocket limits of around $2000–$3000 per year. If you're a person who is in relatively good health and requires minimal medical treatment, this limit may seem quite high. However, a person with a chronic condition or one who suddenly needs to undergo surgery may pass this limit in weeks or months. Such a person may only have to pay that amount while receiving treatments worth tens of thousands.

Having a low out-of-pocket limit has its advantages and so does having a high one. If your policy includes such limits, it may have an impact on your premiums or your lifetime maximum. The important thing is to ensure you have a policy that can offer you the coverage you need when you need it most.

Is There Always a Limit?

Unfortunately, not all health insurance policies have an out-of-pocket limit. Even for those that do, there will be additional factors to consider. These will include which payments count towards the limit and the lifetime maximum.

If you achieve your lifetime maximum, your insurance provider will no longer be required to cover your medical expenses.

Choosing Supplements

You can buy insurance to cover what your primary insurer doesn't. If you are on Medicare, medicare supplements are a prominent example. You pay a premium so that this insurance covers what's left over after Medicare pays their portion. It's a great way to control your out of pocket expenses.