In plain English
This is the part of covered health care costs for the plan year that the insured person still has to pay personally. It is the unpaid amount left before that person's spending reaches the plan's cap on personal cost for covered care.
In context
Here, it reports how much the insured person still has to pay for covered health care during the plan year before the plan's out-of-pocket maximum is reached.
- Situation
- Reading premium, deductible, excess, copay, limit, and out-of-pocket fields
- What it communicates
- shows out-of-pocket accumulator progress in the member portal
Meaning limits
The term alone does not show whether a particular health care charge will count toward reducing this amount.
Examples
“After paying $5,100 for covered care this plan year, Mia's remaining out-of-pocket was $900 before she reached her $6,000 maximum.”
“The monthly summary shows $900 as her remaining out-of-pocket for covered health care this plan year.”