What is an 'out-of-pocket maximum' in a health insurance plan?

OUT-OF-POCKET MAXIMUM (OOP max): The MOST an insured will have to pay for COVERED services in a plan year. INCLUDES: deductible + copayments + coinsurance for covered, in-network services; DOES NOT include: premiums, out-of-network charges (in many plans), balance billing, or non-covered services; ONCE REACHED: The plan pays 100% of covered, in-network services for the rest of the plan year — the insured pays nothing more for covered care; PURPOSE: Protects the insured from catastrophic medical costs — caps their financial exposure; ACA: Sets annual limits on the maximum OOP for marketplace/major medical plans; EXAMPLE: With a $7,000 OOP max, once the insured's covered cost-sharing totals $7,000, the plan covers 100% of further covered care that year; the out-of-pocket maximum is a critical consumer protection and cost-sharing concept on the health insurance exam — it's the ceiling on what the insured pays, providing financial protection against major medical expenses.