Hitting The “Out-of-Pocket Maximum” : Is Everything Else Covered? by Barbara Kempen | Nov 12, 2015 | Affordable Health Insurance, Health Insurance Brentwood, Health Insurance Pacific Palisades, Health Insurance Santa Monica So, you have paid the out-of-pocket maximum (rates varying depending on what type of plan you have) under the Affordable Care Act. Does this mean that everything else is now covered? Unfortunately not. Despite having hit the maximum, you will still have to pay any health insurance premiums, any treatments not directly covered buyout health insurance plan (usually things such as cosmetic surgery), items not deemed as “medical necessities”, and out-of-network expenses. In this case, it’s key to inform yourself of several important details. Know which providers are in your network and which aren’t. Understand what type of plan you have. If your health insurance plan does not accept your covered provider (and does not offer out of network coverage) your medical expenses will ultimately not be covered, even taking into consideration your out-of-pocket maximum. Many Californians are overwhelmed by the task of figuring out the new affordable care acts and how to maximize the benefits for your family. As your agent, we can help. Email us at firstname.lastname@example.org or receive a free premium quote. We will make sure that we find you and your family an affordable health plan in California for 2016.