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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 Marketplace plans varies, but canโ€™t go over a set amount each year.
For the 2024 plan year:ย The out-of-pocket limit for a Marketplace plan canโ€™t be more thanย $9,450 for an individual andย $18,900ย for a family.