Helping Oregon's Local Business Owners Find the Best Healthcare Plans for Their Companies and Employees

Out-of-Pocket Expense Questions

When I reached my out of pocket maximum, I was still charged when I went to the doctor. Is that a mistake?

The out of pocket maximum is the most you will pay under your insurance plan, however, it does not include copays or prescriptions. So, if you were in the hospital and met your out of pocket maximum of $3,000 and then went to the doctor for a check up, you would be subject to your copay and / or any prescriptions that were related to that illness. The maximum is to ensure that you have met your deductible and paid your co-insurance so if anything else major happens, it would be covered at 100%.

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