Out-of-Pocket Limit

Out-of-Pocket Limit

Sun, 07/18/2021 - 15:01

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 2021 Marketplace plan is $8,550 for an individual plan and $17,100 for a family plan.

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Out-of-Pocket Maximum

• When does my plan pay 100%?