The term is also referred to as Out-of-Pocket Maximum.
The most you have to pay for covered services in a plan year. After you spend this amount on deductibles, copayments, and coinsurance, your health plan pays 100% of the costs of covered healthcare services.
♦ One of the results of the Affordable Care Act was that after 2014 copayments count toward the out-of-pocket maximum.
In 2023, the maximum is $9,100 for an individual plan and $18,200 for a family plan.
• When does my plan pay 100%?