An out-of-pocket maximum is a cap or limit on the amount of money you have to pay for covered health care services in a plan year. It is the most you have to pay per year for covered healthcare services, and once you have spent 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 maximum does not include your monthly premiums, anything you spend for services your plan doesnt cover, out-of-network care and services, or costs above the allowed amount for a service that a provider may charge.

Here are some key points to understand about out-of-pocket maximums:

• The out-of-pocket maximum is the most that youll have to pay for covered medical services in a given year.
• It includes your deductible, copayments, and coinsurance.
• Once you meet your out-of-pocket maximum, your insurance plan takes over and covers 100% of eligible medical costs for the remainder of the year.
• The out-of-pocket maximum varies depending on the type of plan you choose, but there are set limits for these out-of-pocket maximums if you buy a plan on your own and not through an employer.
• The out-of-pocket maximum resets at the start of each new policy year.

Its important to note that not every plan has an out-of-pocket maximum, so if this is a benefit you’re interested in, be sure to read plan details carefully.