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Friday, December 12, 2025

Exceeded Out Of Pocket (OOP) Maximum for Health Insurance

The bad news is I am over my out of pocket (OOP) maximum health care insurance cost for this year.  The good news is I am over my OOP health care insurance cost maximum for this year.

The reason for the bad news?   I am having more health care issues than usual that require medical attention.  When I was younger, I hardly ever went to the doctor, despite having excellent medical insurance. Sometimes I would go 5 years without seeing a doctor, despite being active in sports like rugby.  Since retiring, I have had more reasons to seek medical attention, due primarily due to treatment of coronary heart disease and  age related issues, such as joint pain and arthritis..

The reason for the good news?  Once I meet my OOP maximum, 100% of my medical costs are paid by insurance, including copays and coinsurance.   My cost is now $0 for the rest of the year.   As a result, I am scheduling appointments for some of the non urgent medical issues that I would do in future, right now.    That way I can get an earlier evaluation this year, for no cost to me.

This is the second year in a row that I have exceeded my OOP maximum.   

Of course, everyone's insurance is different and YMMV depending on one's insurance policy.  

For more on Reaping the Rewards, check back every Friday for a new segment.

This is not financial nor healthcare advice. Please consult a professional advisor.

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