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Annual maximum limit on out-of-pocket costs

The annual maximum limit on out-of-pocket costs refers to the maximum amount that you have to pay for your reimbursable medicines in one calendar year (1 January to 31 December). In 2023, the annual maximum is set at EUR 592.16.

Once you have reached the annual maximum limit, you can get an additional reimbursement. The additional reimbursement means that you will pay only a EUR 2.50 copayment for each medicine you buy for the rest of the year.

If the price of the medicine you have been prescribed exceeds its reference price and you do not agree to generic substitution, you will also have to pay the amount that exceeds the reference price.

When you reach the annual maximum limit, the pharmacy receives the information from Kela immediately in connection with the medicine purchase. You will usually be reimbursed for your medicine purchases directly at the pharmacy after you have reached the initial deductible.

How to claim reimbursement for medicine expenses.

Progress towards the annual maximum limit on out-of-pocket costs

You make progress towards the annual maximum limit on out-of-pocket costs when you purchase medicines that are part of the reimbursement scheme. The initial deductible that you will have already paid and the medicine expenses you pay yourself after the deduction of reimbursements count towards the annual maximum limit.

However, should the price of the medicine exceed its reference price, the exceeding part does not count towards the annual maximum limit.

You also make progress towards the annual maximum limit when you purchase medicines that

  • have been paid by a workplace sickness fund
  • Kela or the municipality has paid as part of social assistance
  • have been reimbursed through a voluntary insurance.

The annual maximum does not include medicines that you received free of charge from the pharmacy (e.g. due to a traffic accident or an accident at work).

Track your progress towards the annual maximum limit on out-of-pocket costs

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Last modified 14/2/2024

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