Out-of-pocket maximum

One important thing to consider when looking at health insurance plans is the annual out-of-pocket maximum. An out-of-pocket maximum, or out-of-pocket limit, is the cap on the amount of money that you will pay in a year towards covered medical care. This includes deductibles, copayments, and coinsurance for in-network care and services.

Once you have hit your out-of-pocket maximum your insurance will pay 100% of medical costs covered under your plan for the rest of the year. This amount varies, but for the 2022 plan year: the out-of-pocket limit for a Marketplace plan can’t be more than $8,700 for an individual and $17,400 for a family.

It’s also important to note that your out-of-pocket maximum does not include:

  • Monthly premiums
  • Out-of-network care
  • Services that your plan doesn’t cover
  • Costs above the allowed amount for a service that a provider may charge