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.
The maximum out-of-pocket limit for any 2020 Marketplace plan is $8,150 for an individual plan and $16,300 for a family plan.
The maximum out-of-pocket limit for any 2021 Marketplace plan is $8,550 for an individual plan and $17,100 for a family plan.
• When does my plan pay 100%?