@arnblt Guzelce anlasilmasi icin:
Here’s an example of how an out-of-pocket maximum might work, depending on the health plan:
Jane Q. has a health plan with a $2,500 deductible, 20% coinsurance, and a $4,000 out-of-pocket maximum.
At the start of her plan year she has an unexpected illness. She sees her regular doctor and a number of specialists. She goes through a lot of medical tests.
She receives medical bills totaling $2,500 and pays these costs. This meets her deductible. Since she pays this money out of her own pocket, it also counts toward her out-of-pocket maximum.
She continues to see specialists regularly and has to have another round of tests.
She pays 20% coinsurance as her share of these medical costs, while her health plan pays the other 80%. Her bills amount to $1,500. This also counts toward the out-of-pocket max.
At this point, Jane has spent a total of $4,000 and has met her out-of-pocket maximum.
Now, her health plan will begin to pay 100% of her costs for covered care for the rest of the plan year.
Link: https://www.cigna.com/individuals-families/understanding-insurance/what-is-an-out-of-pocket-maximum