Out of Pocket Maximum Changing for Qualifying Life Event?

Suppose (simplifying here):

I am on a health insurance plan with an out of pocket maximum of $4k, a deductible of $0, and co-insurance of 100%. I have already had $100k of medical costs.

In this situation, it’s clear that I would have paid $4k out of pocket and the insurance company would have covered $96k.

Now, suppose I have a birth (qualifying life event), and I downgrade my plan to one with an out of pocket maximum of $8k.

Two questions:

If I do not have any more medical costs for the rest of the year, so I need to pay up the $8k-4k = $4k difference to the health insurance company (i.e. is the out-of-pocket-maximum change retroactive)? If I DO have another medical procedure and it costs $2k, what do i end up paying? Do I pay $2k to the insurance company because my out of pocket maximum has increased? Or do I pay nothing because I’ve already had $100k of medical costs and technically already gone past my $8k out-of-pocket maximum?

I’ve called my health insurance company and the people on the phone are incompetent and don’t understand my question.

submitted by /u/pomeloroad
[link] [comments]Suppose (simplifying here): I am on a health insurance plan with an out of pocket maximum of $4k, a deductible of $0, and co-insurance of 100%. I have already had $100k of medical costs. In this situation, it’s clear that I would have paid $4k out of pocket and the insurance company would have covered $96k. Now, suppose I have a birth (qualifying life event), and I downgrade my plan to one with an out of pocket maximum of $8k. Two questions: If I do not have any more medical costs for the rest of the year, so I need to pay up the $8k-4k = $4k difference to the health insurance company (i.e. is the out-of-pocket-maximum change retroactive)? If I DO have another medical procedure and it costs $2k, what do i end up paying? Do I pay $2k to the insurance company because my out of pocket maximum has increased? Or do I pay nothing because I’ve already had $100k of medical costs and technically already gone past my $8k out-of-pocket maximum? I’ve called my health insurance company and the people on the phone are incompetent and don’t understand my question. submitted by /u/pomeloroad [link] [comments]Read Morer/HealthInsurance

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