Out of Pocket Maximum

When it comes to family health insurance, understanding out-of-pocket maximums can get tricky. Does it matter if the individual or family maximum is met first? Absolutely. The order can impact both what patients pay and what providers should collect. Once either maximum is reached, no additional copays, coinsurance, or deductible amounts should be charged for that member—or for the entire family if the family maximum is met. This guide explains how the two limits work together and why it’s important for both patients and billing staff to keep track.