Out-of-Pocket Maximum (Healthcare) - Definition, Examples, Advice | Bolder Money

Acupuncture Visit Benefit Acupuncture Visit Benefit

Adjustment Adjustment

Adjustment Code Adjustment Code

Admission Fee Admission Fee

Adoption Medical Assistance Adoption Medical Assistance

Air Ambulance Membership Air Ambulance Membership

Allowed Amount Allowed Amount

Ambulatory Service Fee Ambulatory Service Fee

Ambulatory Surgery Center Fee Ambulatory Surgery Center Fee

Ancillary Service Fee Ancillary Service Fee

Appeal Process Appeal Process

Authorization Code Authorization Code

Balance Carried Forward Balance Carried Forward

Balance Due Balance Due

Balance Forward Balance Forward

Billing Code Billing Code

Billing Department Billing Department

Billing Department Contact Billing Department Contact

Billing Statement Billing Statement

Biometric Screening Reward Biometric Screening Reward

Brand-Name Medication Option Brand-Name Medication Option

Breastfeeding Support Benefit Breastfeeding Support Benefit

CPT Code CPT Code

Catastrophic Illness Relief Fund Catastrophic Illness Relief Fund

Charge Capture Charge Capture

Charge Date Charge Date

Charge Description Charge Description

Charity Care Indicator Charity Care Indicator

Chiropractic Visit Benefit Chiropractic Visit Benefit

Chronic Condition Support Chronic Condition Support

Chronic Disease Management Plan Chronic Disease Management Plan

Claim Denial Claim Denial

Claim Number Claim Number

Claim Submission Date Claim Submission Date

Coinsurance Percentage Coinsurance Percentage

Consultation Fee Consultation Fee

Contracted Rate Contracted Rate

Coordination of Benefits Coordination of Benefits

Copay Reminder Copay Reminder

Counseling Session Allowance Counseling Session Allowance

Current Balance Current Balance

Current Charges Current Charges

Date of Service Date of Service

Denial Reason Denial Reason

Diagnosis Code Diagnosis Code

Discounted Charge Discounted Charge

Durable Medical Equipment Benefit Durable Medical Equipment Benefit

Emergency Room Fee Emergency Room Fee

Emergency Transportation Fund Emergency Transportation Fund

Employee Wellness Stipend Employee Wellness Stipend

Employer-Sponsored Healthcare Plan Employer-Sponsored Healthcare Plan

Explanation of Benefits Explanation of Benefits

Eye Surgery Cost Plan Eye Surgery Cost Plan

Facility Fee Facility Fee

Final Balance Final Balance

Financial Assistance Note Financial Assistance Note

Financial Summary Financial Summary

Flexible Spending Account (FSA)Flexible Spending Account (FSA)

Generic Medication Option Generic Medication Option

Health Savings Account (HSA)Health Savings Account (HSA)

Hearing Aid Upgrade Benefit Hearing Aid Upgrade Benefit

Hearing Services Benefit Hearing Services Benefit

Home Infusion Therapy Benefit Home Infusion Therapy Benefit

Hospital Bill Negotiation Service Hospital Bill Negotiation Service

Hospital Day Pass Hospital Day Pass

Hospital Financial Counselor Hospital Financial Counselor

Hospital Payment Plan Hospital Payment Plan

Hospital Room Upgrade Fee Hospital Room Upgrade Fee

ICD Code ICD Code

Imaging Fee Imaging Fee

Infertility Treatment Option Infertility Treatment Option

Inpatient Service Fee Inpatient Service Fee

Insurance Coverage Insurance Coverage

Insurance ID Insurance ID

Insurance Payment Insurance Payment

Itemized Bill Itemized Bill

Itemized Charges Itemized Charges

Lab Charge Lab Charge

Lab Test Discount Lab Test Discount

Late Fee Notice Late Fee Notice

Late Payment Fee Late Payment Fee

Lifestyle Change Incentive Lifestyle Change Incentive

Lifestyle Management Program Lifestyle Management Program

Low-Income Clinic Support Low-Income Clinic Support

Maternity Nurse Hotline Maternity Nurse Hotline

Medical Bill Installments Medical Bill Installments

Medical Bill Settlement Option Medical Bill Settlement Option

Medical Cost-Sharing Group Medical Cost-Sharing Group

Medical Invoice Advocate Medical Invoice Advocate

Medical Record Number Medical Record Number

Medical Tourism Policy Medical Tourism Policy

Medication Charge Medication Charge

Mental Health Crisis Fund Mental Health Crisis Fund

Mental Health Hotline Mental Health Hotline

Mental Wellness Day Benefit Mental Wellness Day Benefit

Negotiated Rate Negotiated Rate

Neonatal Intensive Care Benefit Neonatal Intensive Care Benefit

Newborn Care Benefits Newborn Care Benefits

Non-Contracted Rate Non-Contracted Rate

Non-Covered Charges Non-Covered Charges

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Definition

The most you have to pay during a plan year for covered healthcare services, after which your insurance covers 100%.

What to consider

Research thoroughly as these markets are less regulated.
Consider the liquidity risks involved in OTC trading.
Review the transparency of the companies before investing.

Real world scenarios

After a series of unexpected medical bills, Liam was relieved to reach his insurance plan’s out-of-pocket maximum, after which his insurance covered 100% of the remaining costs.

Related terms

Healthcare

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