Out-of-pocket maximum/limit
The most you have to pay for covered services in a plan year. After you spend this amount on
,
, and
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
- 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 a Marketplace plan for plan year:
- 2026: No more than $10,600 for an individual or $21,200 for a family
- 2027: No more than $12,000 for an individual or $24,000 for a family