Question: Nobody at Covered California can tell me what my out of pocket maximum would be. The website says 2250 per my income and plan choice, but when I call Healthnet directly they told me my out of pocket max could be up to 12K if I go out of network. Nowhere is any of Covered CA does it state that. What is the right answer?
Answer: Apparently your income makes you eligible for an Enhanced Silver Plan with an out-of-pocket maximum of $2250. That's a great deal. If you are smart about utilizing your benefits, you should never have an out-of-network bill of any kind much less have to worry about the out-of-network annual maximum, but the Health Net rep was right, you would have to spend $12,000 out-of-pocket before you are covered 100% out of network.