Out-of-Pocket Limit
The term is also referred to as Out-of-Pocket Maximum.
The most you have to pay for covered services in a plan year. After you spend this amount on deductibles, copayments, and coinsurance, your health plan pays 100% of the costs of covered healthcare services.
♦ One of the results of the Affordable Care Act was that after 2014 copayments count toward the out-of-pocket maximum.
In 2025, the maximum is $9,200 for an individual plan and $18,400 for a family plan.
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• When does my plan pay 100%?
