Health Insurance Basics
What is a health insurance out-of-pocket maximum?
The out-of-pocket maximum is the most you will pay for covered medical services in a plan year. After reaching the out-of-pocket maximum, the insurance pays 100% of covered services for the rest of the year. The out-of-pocket maximum includes deductibles, copays, and coinsurance.
Key Points
- OOP max: most you will pay for covered services in a plan year
- After OOP max: insurance pays 100% of covered services
- Includes deductibles, copays, and coinsurance
- 2026 ACA OOP max: $9,450 individual, $18,900 family
- An independent agent can help you compare plans based on OOP max