Health Insurance Basics
What is a health insurance out-of-pocket maximum?
The out-of-pocket maximum (OOP max) is the most you will pay for covered health care services in a plan year. After you reach the OOP max, your insurance pays 100% of covered services for the rest of the year. In 2026, the ACA OOP max limit is $9,450 for individuals and $18,900 for families.
Key Points
- OOP max: most you pay for covered services in a plan year
- After OOP max: insurance pays 100% of covered services
- 2026 ACA OOP max limit: $9,450 individual, $18,900 family
- Deductibles, copays, and coinsurance all count toward the OOP max
- Lower OOP max = better protection against catastrophic costs