Out-of-Pocket Maximum

The max you'll pay for covered care
tl;drOut-of-pocket maximum is the most you'd ever have to pay in a year towards covered medical care

An out-of-pocket maximum, or out-of-pocket limit, is the ceiling 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.

How much is my out-of-pocket maximum?

This amount varies each year.

  • For 2024, the out-of-pocket maximum for a Marketplace plan is $9,450 for an individual and $18,900 for a family.

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