Stop-Loss (Out of Pocket Maximum/Maximum Out of Pocket)
Stop-loss, also known as out-of-pocket maximum (OOPM) or maximum out-of-pocket, is the highest amount of money you have to pay for covered healthcare services in a plan year. After you reach your stop-loss, your health insurance plan pays 100% of the costs of covered benefits.
Stop-loss amounts vary depending on the health insurance plan. In general, the higher your premium, the lower your stop-loss will be.
Here is an example of how stop-loss works:
- You have a health insurance plan with a $5,000 stop-loss.
- You have a medical emergency and incur $100,000 in medical bills.
- Your health insurance plan will pay 80% of the covered medical bills, and you will be responsible for the remaining 20% (copay, coinsurance, and deductible).
- You will pay $20,000 out of pocket for your medical bills.
- Once you reach your stop-loss of $5,000, your health insurance plan will pay 100% of the remaining covered medical bills.
Stop-loss can be an important financial protection for people with high medical costs. It can help you avoid having to pay a large amount of money out of pocket for covered healthcare services.
Here are some tips for choosing a health insurance plan with a good stop-loss amount:
- Consider your health needs and the likelihood of incurring high medical costs.
- Compare stop-loss amounts from multiple health insurance plans.
- Choose a plan that fits your budget and meets your needs.
If you have any questions about stop-loss or choosing a health insurance plan, you should speak with a financial advisor.