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