Question

WRITE A 1000 WORD ESSAY for "Out of pocket expenditure"... This topic comes under Health Economics and plz make sure it has min 1000 words....Use the APA format you can search for it online....

Answer 1

“Out of pocket” just means whatever you pay for (not covered by insurance.) You might have to pay because you don’t have insurance, or because your insurance doesn’t cover something (experimental treatment, prescriptions, etc), or because you needed care in another state or country outside of your covered network, or because you have a deductible amount you have to cover before insurance kicks in.

      To put in an easy to understand answer, the out of pocket limit or "max out of pocket" is the absolute most money that you as the policy owner will have to spend in your policy calendar year. Calendar year is the 12 months your policy lasts. So you purchase a policy in January and it ends January. Your deductible is 1,500 with a max out of pocket of 3,000. From that JAN to JAN the most you can spend is 3,000 PERIOD is 3,000 out of your own pocket. After that the insurance company pays 100% of all your bills UNTIL the calendar year is over

      An out-of-pocket limit is the maximum amount you, as the covered beneficiary, will pay in cost-sharing during a specified time period - usually the plan year.

Health insurance policies typically involve three general types of patient cost-sharing (often demarcated by type of service - outpatient, inpatient, prescription drugs, etc.), aimed at encouraging judicious use of expensive medical resources:

• Deductibles are first-dollar amounts for which the patient is responsible. A typical deductible is $500, and the patient must pay for any care up to that amount before the insurance coverage kicks in. These are unpopular, though, so many health insurance companies tout $0 deductibles with their plans.

• Coinsurance is a percentage of the bill that the patient must pay. Coinsurance is typically set at 20%, but the amount may vary by plan and by service. Patients don't usually love these because they're unpredictable, which leads us to...

• Copays, or fixed dollar amounts for different types of services - $10 to see a primary care physician, $20 for a specialist, etc. These are the most popular type of cost sharing as far as I know, but are probably the least effective at containing patients' health care spending.

An out-of-pocket limit is a means to protect patients from the aggregate impact of cost-sharing - even if a patient needs substantial medical care during the plan year, they will not spend more than that amount; the insurer will cover the rest of their care costs.