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You share the cost of your care with your health insurance company. You pay money to cover your deductible, coinsurance and copays. But here’s some good news: There is a limit to how much you are required to pay. It’s called your out-of-pocket maximum (OOPM). And it is the most you’ll have to pay during a policy period – usually a year – for health care services.
If you are a current BCBSNM member, you can see your plan’s OOPM in Blue Access for MembersSM. It’s different for every type of plan. Here are some things to keep in mind:
Take this scenario for example: Joe’s plan has a $8,700 out-of-pocket maximum. That is the most Joe will pay this year out of his own pocket for covered medical expenses. Joe only pays for the medical care he uses. If he’s healthy, he may only pay for a few doctor visits and prescriptions, but if he has an accident or major illness, that accident or illness could mean costly hospital bills. However, because Joe has health insurance and stays in network, he won’t have to pay more than $8,700 for covered expenses this year, even if his care costs more.
Read more about a deductible vs out of pocket maximum.
Before you even choose a health insurance plan, it’s important to first consider your plan’s doctor network. Our Provider Finder® tool will help you know if your doctor and hospital of choice are in a plan's network.
It’s a lot to digest, so if you still have a few questions about your out-of-pocket maximum, ask us in the comments!
Originally published 8/21/2015; Revised 2022
Blue Cross and Blue Shield of New Mexico, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association
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