Your maximum out-of-pocket amount is the most you can pay for covered health care in a 12-month period. It includes your deductible, eligible copays and eligible coinsurance payments. Your MOOP does not include your monthly premium payments.
Most payments that you make after receiving care go toward your MOOP. Once you pay the total of your MOOP amount, your plan will begin to pay for 100% of your covered benefits until the MOOP “resets” at zero in the next coverage year.
Your claim listing (also called audit report) is a summary of the services you received and how they contribute to your MOOP amount. Use it to keep track of how much your providers have charged toward your MOOP amount.
Your maximum out-of-pocket amount is just one part of understanding how cost-sharing works in your health plan. Read more about how health insurance works, complete with a step-by-step example for
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