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 can’t go over a set amount each year.
- For the 2024 plan year: The out-of-pocket limit for a Marketplace plan can’t be more than $9,450 for an individual and $18,900 for a family.
- For the 2025 plan year: The out-of-pocket limit for a Marketplace plan can't be more than $9,200 for an individual and $18,400 for a family.