Out-of-Pocket Maximum

Insurance

Out-of-pocket maximum is the most you'll pay for covered healthcare in a plan year (deductible + coinsurance + copays). Once reached, insurance pays 100% of in-network covered services for the remainder of the year. ACA limits for 2026: $9,200 individual, $18,400 family. HSA-eligible HDHP maximums are slightly lower. Out-of-pocket max doesn't include premiums, out-of-network charges, non-covered services, or balance-billed amounts. Crucial for catastrophic financial planning — a serious medical event maxes you at OOP, not unlimited liability. Compare plans on the realistic worst-case OOP, not just premiums.