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 for in-network care and services, your health plan pays 100% of the costs of covered benefits.

The out-of-pocket limit doesn’t include:

Your monthly premiums

• Anything you spend for services your plan doesn’t cover
• Out-of-network care and services
• Costs above the allowed amount for a service that a provider may charge

The out-of-pocket limit for Marketplace plans varies, but can’t go over a set amount each year.