What is the “cap” on out of pocket expenses for a fee-for-service plan?
• A: Most fee-for-service plans have a “cap,” the most you will have to pay for medical bills in any one year. You reach the cap when your out-of-pocket expenses (for your deductible and your coinsurance) total a certain amount. It may be as low as $1,000 or as high as $5,000. Then the insurance company pays the full amount in excess of the cap for the items your policy says it will cover. The cap doesn’t include what you pay for your monthly premium. Some services are limited or not covered at all. You need to check on preventive health care coverage such as immunizations and well-child care.