What is an 'out-of-pocket maximum'?

The out-of-pocket maximum (OOP max) is the total amount the insured can pay for covered services in a plan year. Once the insured reaches this limit (through deductibles, copays, and co-insurance combined), the plan pays 100% of covered services for the rest of the year. Premiums do not count toward the OOP max. Out-of-network costs do not count for many plans. ACA-compliant plans had OOP max limits around $9,450 for individuals in 2024 (the limit is indexed annually). The OOP max provides protection against catastrophic costs from a serious illness or accident. When comparing plans, the OOP max is often more important than the deductible because it represents the worst-case annual exposure.