Dr. Michael Lee graduated from Stanford University with honors and received his medical degree from the University of Chicago in 1996. Dr. Lee completed his internal medicine residency at Mount Auburn Hospital, a Harvard Medical School teaching hospital.

How do I choose health insurance for 2014? Tip #1 Look at The Out of Network Annual Out of Pocket Maximum

If you are traveling out of state and need to be treated by a doctor that is not in your network or you need to be treated at a national medicial center that is not in you network, there is one number which will become all important to you.

    The Out of Network Annual Out of Pocket Maximum.

I live in Washington and was surprised to find that every health plan on our health insurance exchange wahealthplanfinder.org that offers Out of Network coverage has an Annual Out of Pocket Maximum that is unlimited.

Let’s take an extreme case where you rack up a $200,000 bill out of network. If your deductible is $10,000 and your coinsurance is 50% (percentage you pay after you meet your deductible), you’ll also be on the hook for half of the remaining $190,000. Total expense is $10,000 + 50% of $190,000 = $105,000.

So far, I know of one insurance company, Regence Individual Direct Plans, that has an Out of Network Annual Out of Pocket Maximum of $12,500. Surprisingly, you won’t find it on the exchange. You have to go directly to the Regence website.

Bonus tip: Not all insurance plans are on the health insurance exchange websites.

So with a $10,000 deductible, your total expense is $10,000 + 50% of $190,000 (up to a max of $12,500) = $22,500. For me, the Bronze level of this plan is $280/month.

The cheapest exchange plan that offers Out of Network Annual Out of Pocket Maximum that is unlimited costs $253/month.

Most healthy people will not need to be seen out of network, but it’s at least worth knowing that there are options to limit your potential liability.


  1. Douglas MacQuarrie Said,

    November 20, 2013 @ 8:18 am

    Michael , where would I find that article on a Fish Oil?

  2. drmikelee Said,

    November 20, 2013 @ 9:38 pm

    Hi Doug, I’ll put it under the post on Triglycerides.

Leave a Comment