Maximum out-of-pocket expenses can be scary

The deductible and out-of-pocket maximum for your healthcare plan reset every year on January 1. This is especially important to highlight because many people have completed their open enrollment for the new year by now. And if you are like most people, you try to get through it as fast as possible without understanding the true value and cost associated with your health plans. If you haven’t obtained coverage, you are in luck. There is a special enrollment period open until May 15th.

This year there is a significant change affecting health plans’ design and administration – non-grandfathered health plans will be subject to limits on cost-sharing for essential health benefits (EHB). The annual limit on total grand enrollment cost-sharing for EHB for plan years beginning on or after January 1, 2021, is $8,550 for self-only coverage and $17,100 for family coverage, a 16% increase in just four years.

I know that these numbers seem high, and they are. You may even be thinking, what’s the point in having health insurance if I can’t even access it until I spend thousands of dollars? I completely understand the notion that it might seem like you don’t even have insurance at this point. However, I’m here to say that you absolutely do, and it is still essential to attain coverage for yourself and your family. The maximum out-of-pocket spend is the biggest hindrance I see to people buying insurance, and correspondingly, the biggest mistake!

When people opt out of insurance, it creates a chain reaction that becomes much more expensive for all involved.

If someone doesn’t have coverage, they are less likely to go to the doctor. In turn, this means they may come to work sick and run the risk of infecting others. Flu season is upon us, and we just don’t know what that will look like this year during COVID19. One sick, uninsured person coming to the office can create a domino effect.

Thankfully, there are creative ways to help remedy the fear of maximum out-of-pocket spend. We can create innovative plan designs and workarounds to mitigate these costs.

A couple of solutions to help mitigate costs include:

– Access to telehealth

– Gap plans

– MDLIVE – a specialized program we offer

It just takes creative thinking and execution to help all of the working families. We have more solutions to help lower your costs and eliminate confusion surrounding maximum-out-of pocket and insurance premiums.

At Sapoznik Insurance, a World Insurance Associates company, we have built the roadmap to navigate today’s healthcare challenges and provide solutions for tomorrow. If you want to challenge the status quo, quo or need assistance in understanding the new legislation, please call or email me at 305.948.8887 or

As a reminder, if you haven’t obtained coverage, you are in luck. There is a special enrollment period open until May 15th.