The most you have to pay for covered services in a plan year. After you spend this amount on deductibles, copayments, and coinsurance for in-network care and services, your health plan pays 100% of the costs of covered benefits.
The out-of-pocket limit doesn't include:
- Your monthly premiums
- Anything you spend for services your plan doesn't cover
- Out-of-network care and services
- Costs above the allowed amount for a service that a provider may charge
The out-of-pocket limit for Marketplace plans varies, but can’t go over a set amount each year.
- For the 2020 plan year: The out-of-pocket limit for a Marketplace plan can’t be more than $8,150 for an individual and $16,300 for a family.
- For the 2019 plan year: The out-of-pocket limit for a Marketplace plan couldn’t be more than $7,900 for an individual and $15,800 for a family.